1720443088 NPI number — PALOMA MARIA PEREZ

Table of content: JEANETTE LAU PHARMD (NPI 1255524112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720443088 NPI number — PALOMA MARIA PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
PALOMA
Provider Middle Name:
MARIA
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:
1720443088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 CALLE PALMA
Provider Second Line Business Mailing Address:
URBANIZACION COCO BEACH
Provider Business Mailing Address City Name:
RIO GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-642-4540
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 CALLE PALMA
Provider Second Line Business Practice Location Address:
URB COCO BEACH
Provider Business Practice Location Address City Name:
RIO GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00745-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-642-4540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2015

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: 2355S0801X , with the licence number:  5004 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 1318 , 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)