1801187554 NPI number — MISS CYNTHIA ODALY ROBLES PEREZ

Table of content: MISS CYNTHIA ODALY ROBLES PEREZ (NPI 1801187554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801187554 NPI number — MISS CYNTHIA ODALY ROBLES PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBLES PEREZ
Provider First Name:
CYNTHIA
Provider Middle Name:
ODALY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
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:
1801187554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUQUILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00773-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-617-2984
Provider Business Mailing Address Fax Number:
787-889-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VISTAS DE LUQUILLO 2
Provider Second Line Business Practice Location Address:
CALLE ZAFIRO 621
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-617-2984
Provider Business Practice Location Address Fax Number:
787-889-5030
Provider Enumeration Date:
04/28/2011

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:  1312 , 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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