1659447514 NPI number — MIRELIS MIRANADA GALLOZA

Table of content: MIRELIS MIRANADA GALLOZA (NPI 1659447514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659447514 NPI number — MIRELIS MIRANADA GALLOZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANADA GALLOZA
Provider First Name:
MIRELIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1659447514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 3 BOX 31531
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-9757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-238-2923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 CALLE CONCEPCION VERA AYALA
Provider Second Line Business Practice Location Address:
HOSPITAL SAN CARLOS BORROMEO
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676-0068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-877-8000
Provider Business Practice Location Address Fax Number:
787-551-7066
Provider Enumeration Date:
11/24/2006

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: 207R00000X , with the licence number:  16589 , 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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