1659697944 NPI number — DANA MIRO MEDINA

Table of content: DANA MIRO MEDINA (NPI 1659697944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659697944 NPI number — DANA MIRO MEDINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRO MEDINA
Provider First Name:
DANA
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:
1659697944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A4 CALLE 2 MANSIONES DE GARDEN HILLS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-943-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CARR. 165 TORRE 1 SUITE C-107
Provider Second Line Business Practice Location Address:
CENTRO INTERNACIONAL DE MERCADEO
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-999-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2010

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: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1558 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".




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