1659379303 NPI number — DR. LUIS ALBERTO DOMINGUEZ CARRAZQUILLO DDS

Table of content: DR. LUIS ALBERTO DOMINGUEZ CARRAZQUILLO DDS (NPI 1659379303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659379303 NPI number — DR. LUIS ALBERTO DOMINGUEZ CARRAZQUILLO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINGUEZ CARRAZQUILLO
Provider First Name:
LUIS
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1659379303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 623
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYAMA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00785-0623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-866-3631
Provider Business Mailing Address Fax Number:
787-866-8690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE PALMER SUR #24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUAYAMA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00784-7610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-866-3631
Provider Business Practice Location Address Fax Number:
787-866-8690
Provider Enumeration Date:
07/07/2005

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: 1223G0001X , with the licence number:  1099 , 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)

  • Identifier: 40624 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1099 . This is a "MENONITA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 26016 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4-1072 . This is a "TRIPLE SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1099 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6540025 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8634 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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