1720001274 NPI number — MS. BEVERLY ANNETTE RUBIO R.PH.

Table of content: MS. BEVERLY ANNETTE RUBIO R.PH. (NPI 1720001274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720001274 NPI number — MS. BEVERLY ANNETTE RUBIO R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIO
Provider First Name:
BEVERLY
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
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:
1720001274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P5 CALLE 1
Provider Second Line Business Mailing Address:
URB DOS RIOS
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-501-4384
Provider Business Mailing Address Fax Number:
787-784-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR # 2 KM 7.1
Provider Second Line Business Practice Location Address:
SANTA ROSA MALL LOCAL 24
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-786-6306
Provider Business Practice Location Address Fax Number:
787-966-7652
Provider Enumeration Date:
07/25/2006

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: 183500000X , with the licence number:  2573 , 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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