1811328768 NPI number — LATONI PLASTICAND RECONSTRUCTIVE SURGERY PSC

Table of content: (NPI 1811328768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811328768 NPI number — LATONI PLASTICAND RECONSTRUCTIVE SURGERY PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATONI PLASTICAND RECONSTRUCTIVE SURGERY 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:
1811328768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1856
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-831-1000
Provider Business Mailing Address Fax Number:
787-831-1000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 CALLE NELSON PEREA
Provider Second Line Business Practice Location Address:
EDF DOCTORS CENTER SUITE 105
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-831-1000
Provider Business Practice Location Address Fax Number:
787-831-1000
Provider Enumeration Date:
12/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LATONI MALDONADO
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-831-1000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  11812 , 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: 11812 . This is a "MD LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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