1851454417 NPI number — DR. RAFAEL O SANJUAN

Table of content: DR. RAFAEL O SANJUAN (NPI 1851454417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851454417 NPI number — DR. RAFAEL O SANJUAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANJUAN
Provider First Name:
RAFAEL
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1851454417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 LANCASTER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23602-8821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-877-5236
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MCDONALD ARMY HEALTH CENTER
Provider Second Line Business Practice Location Address:
576 JEFFERSON AVE
Provider Business Practice Location Address City Name:
FORT EUSTIS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23604-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-314-7522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)