1740883321 NPI number — HUMBERTO JAFET AYOROA SOSA I

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740883321 NPI number — HUMBERTO JAFET AYOROA SOSA I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYOROA SOSA
Provider First Name:
HUMBERTO
Provider Middle Name:
JAFET
Provider Name Prefix Text:
Provider Name Suffix Text:
I
Provider Credential Text:
Provider Gender Code:
M

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:
1740883321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1696
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-1696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-844-1261
Provider Business Mailing Address Fax Number:
787-872-3721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2Q RUTA 474
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-844-1261
Provider Business Practice Location Address Fax Number:
787-872-3721
Provider Enumeration Date:
11/17/2020

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: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03960304 . This is a "LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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