1801994900 NPI number — WAXALI INC

Table of content: (NPI 1801994900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801994900 NPI number — WAXALI INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAXALI INC
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:
6
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:
1801994900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 72 BOX 3954
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719-8771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-1111
Provider Business Mailing Address Fax Number:
787-869-2318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 803 KM 10.3
Provider Second Line Business Practice Location Address:
BARRIO CEDRO ARRIBA
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719-9722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-1111
Provider Business Practice Location Address Fax Number:
787-869-2318
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO ROSADO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
787-869-1111

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  776 , 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: 776 . This is a "STATE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D0658158 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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