1629310263 NPI number — MELIXA ENITH MANGOME SENATI DPT

Table of content: MELIXA ENITH MANGOME SENATI DPT (NPI 1629310263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629310263 NPI number — MELIXA ENITH MANGOME SENATI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANGOME SENATI
Provider First Name:
MELIXA
Provider Middle Name:
ENITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629310263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00604-0228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-265-0255
Provider Business Mailing Address Fax Number:
787-832-8326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 SEVERIANO CUEVAS
Provider Second Line Business Practice Location Address:
OFICINA 105
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603-5762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-891-2470
Provider Business Practice Location Address Fax Number:
787-658-6113
Provider Enumeration Date:
03/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  000903 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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