1750564498 NPI number — MRS. ALBA IRIS CARBONELL LND

Table of content: FIRAS M KAMIL M.D. (NPI 1134412109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750564498 NPI number — MRS. ALBA IRIS CARBONELL LND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARBONELL
Provider First Name:
ALBA
Provider Middle Name:
IRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LND
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARBONELL
Provider Other First Name:
ALBA
Provider Other Middle Name:
IRIS
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LND
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750564498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 CALLE PEDRO ARZUAGA E
Provider Second Line Business Mailing Address:
VILLAS DEL CENTRO APT. # 52
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00985-6167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-550-5362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 AVE PONCE DE LEON
Provider Second Line Business Practice Location Address:
NUTRITION DEPARTMENT
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-2000
Provider Business Practice Location Address Fax Number:
787-771-7951
Provider Enumeration Date:
12/17/2007

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: 133NN1002X , with the licence number:  1235 , 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)

  • Identifier: 1235 . This is a "LND" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1235 . This is a "CLE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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