1760480180 NPI number — NIZETTE I CORDERO RPT

Table of content: TAREN ADDINGTON RN (NPI 1881099703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760480180 NPI number — NIZETTE I CORDERO RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDERO
Provider First Name:
NIZETTE
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1760480180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
REPARTO MARQUEZ
Provider Second Line Business Mailing Address:
CALLE 9 G-26
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-898-5885
Provider Business Mailing Address Fax Number:
787-898-5885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 129 KM 13.6
Provider Second Line Business Practice Location Address:
BO. BAYANEY
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-898-5885
Provider Business Practice Location Address Fax Number:
787-898-5885
Provider Enumeration Date:
07/09/2005

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: 225100000X , with the licence number:  871 , 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: 89222 . This is a "TRIPLE-S (REFORMA)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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