1871838508 NPI number — DOMINIQUE FRANCHESKA ESPAILLAT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871838508 NPI number — DOMINIQUE FRANCHESKA ESPAILLAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPAILLAT
Provider First Name:
DOMINIQUE
Provider Middle Name:
FRANCHESKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1871838508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB.BRISAS DE ANASCO CALLER 10
Provider Second Line Business Mailing Address:
CASA GG 8
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-996-6770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
METRO OFFICE PARK # 6
Provider Second Line Business Practice Location Address:
CALLE 1 SUITE 101
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-522-5252
Provider Business Practice Location Address Fax Number:
787-522-5253
Provider Enumeration Date:
12/06/2012

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: 183700000X , with the licence number:  5588 , 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: 5588 . This is a "PHARMACIST TECHNICHIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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