1821039165 NPI number — DR. ANTONIO J. DIEZ-SIFONTES MD

Table of content: DR. ANTONIO J. DIEZ-SIFONTES MD (NPI 1821039165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821039165 NPI number — DR. ANTONIO J. DIEZ-SIFONTES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEZ-SIFONTES
Provider First Name:
ANTONIO
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1821039165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-878-3306
Provider Business Mailing Address Fax Number:
787-878-6232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ARECIBO MEDICAL CENTER SUITE #209
Provider Second Line Business Practice Location Address:
CARR. #2 , KM 80.0
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-878-3306
Provider Business Practice Location Address Fax Number:
787-878-6232
Provider Enumeration Date:
06/09/2006

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: 174400000X , with the licence number:  5680 , 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: 5680 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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