1821330705 NPI number — HILDA JUSTINIANO MD, P.S.C.

Table of content: (NPI 1821330705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821330705 NPI number — HILDA JUSTINIANO MD, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILDA JUSTINIANO MD, P.S.C.
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:
1821330705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3047
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:
00681-3047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-806-2222
Provider Business Mailing Address Fax Number:
800-317-9835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR-2 KM 150.2
Provider Second Line Business Practice Location Address:
BARRIO ALGARROBO
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-806-2222
Provider Business Practice Location Address Fax Number:
800-317-9835
Provider Enumeration Date:
03/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JUSTINIANO GARCIA
Authorized Official First Name:
HILDAMARI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-644-7700

Provider Taxonomy Codes

  • Taxonomy code: 207NS0135X , with the licence number:  15662 , 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: HR031A . This is a "PROVIDER TRANSACCTION AUTHORIZATION NUMBER - (PTAN)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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