1629553185 NPI number — MISS KARIM BERRIOS GOMEZ TECH 12072

Table of content: MISS KARIM BERRIOS GOMEZ TECH 12072 (NPI 1629553185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629553185 NPI number — MISS KARIM BERRIOS GOMEZ TECH 12072

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRIOS GOMEZ
Provider First Name:
KARIM
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
TECH 12072
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERRIOS GOMEZ
Provider Other First Name:
KARIM
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629553185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SANTA CLARA #150 CARR 9931 STE1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-687-7997
Provider Business Mailing Address Fax Number:
787-687-7994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 06 RALPH PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-687-7997
Provider Business Practice Location Address Fax Number:
787-687-7994
Provider Enumeration Date:
10/01/2018

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: 156F00000X , with the licence number:  012072 , 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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