1851324362 NPI number — MARIA L CRESPO

Table of content: (NPI 1851324362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851324362 NPI number — MARIA L CRESPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA L CRESPO
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:
1851324362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 791
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00690-0791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-890-6161
Provider Business Mailing Address Fax Number:
787-890-6161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 AVE GENERAL RAMEY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00690-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-890-6161
Provider Business Practice Location Address Fax Number:
787-890-6161
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRESPO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
787-890-6161

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  761 , 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: A0170 . This is a "FIRST PLUS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 051502 . This is a "BLUE CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30731 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20161 . This is a "PREFERRED MEDICARE CHOCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D0711458 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5599 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6030045 . This is a "HUMANA HEALTH/ INS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0152 . This is a "INTERNATIONAL MEDCAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800386 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0179 . This is a "PAN AMERICAN LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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