1790083301 NPI number — JOSE L RIVERA ZAYAS DENTAL PSC

Table of content: MARIA EUGENIA ZULUAGA LCSW (NPI 1295909521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790083301 NPI number — JOSE L RIVERA ZAYAS DENTAL PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE L RIVERA ZAYAS DENTAL PSC
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:
1790083301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364881
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-4881
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-773-0123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 CALLE CESAR GONZALEZ
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-773-0123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA ZAYAS
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-773-0123

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  2107 , 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)





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