1902806912 NPI number — MISS JESSICA IVETTE VILLEGAS RUIZ

Table of content: MISS JESSICA IVETTE VILLEGAS RUIZ (NPI 1902806912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902806912 NPI number — MISS JESSICA IVETTE VILLEGAS RUIZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ
Provider First Name:
JESSICA IVETTE
Provider Middle Name:
VILLEGAS
Provider Name Prefix Text:
MISS
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:
1902806912
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:
AM18 CALLE 29
Provider Second Line Business Mailing Address:
INTERAMERICANA
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-439-1777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 CALLE ACUARIO
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-4990
Provider Business Practice Location Address Fax Number:
787-748-1935
Provider Enumeration Date:
08/01/2005

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:  004015 , 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)





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