1770234429 NPI number — ZULLY RUBI DENTAL LLC

Table of content: (NPI 1770234429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770234429 NPI number — ZULLY RUBI DENTAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZULLY RUBI DENTAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770234429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 HACIENDA DE LA BAUME
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOQUERON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00622-9706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-636-3300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF POLICLINICA BELLA VISTA
Provider Second Line Business Practice Location Address:
770 AVE HOSTOS SUITE 203
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-636-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DE JESUS
Authorized Official First Name:
ZULLY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
787-361-5380

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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