1902954142 NPI number — MS. EDNA G ORTIZ-SANABRIA MD

Table of content: MS. EDNA G ORTIZ-SANABRIA MD (NPI 1902954142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902954142 NPI number — MS. EDNA G ORTIZ-SANABRIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ-SANABRIA
Provider First Name:
EDNA
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902954142
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:
1645 CALLE TAMESIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-1801
Provider Business Mailing Address Fax Number:
787-763-1165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 CALLE DIEGO VEGA
Provider Second Line Business Practice Location Address:
AMELIA
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00965-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-783-4479
Provider Business Practice Location Address Fax Number:
787-783-0059
Provider Enumeration Date:
01/06/2007

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: 208000000X , with the licence number:  9589 , 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: 89477 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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