1699789966 NPI number — IVELISSE DIAZ GARCIA DBA LABORATORIO DIAZ GARCIA

Table of content: (NPI 1699789966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699789966 NPI number — IVELISSE DIAZ GARCIA DBA LABORATORIO DIAZ GARCIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVELISSE DIAZ GARCIA DBA LABORATORIO DIAZ GARCIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699789966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140519
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-0519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-880-4734
Provider Business Mailing Address Fax Number:
787-650-8866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 CALLE JUAN COLON PADILLA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-4461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-880-4734
Provider Business Practice Location Address Fax Number:
787-650-8866
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ GARCIA
Authorized Official First Name:
IVELISSE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-880-4734

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  820 , 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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