1912485541 NPI number — MISS JOANN ALEXANDRA VIDAL RODRIGUEZ I MD

Table of content: MISS JOANN ALEXANDRA VIDAL RODRIGUEZ I MD (NPI 1912485541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912485541 NPI number — MISS JOANN ALEXANDRA VIDAL RODRIGUEZ I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIDAL RODRIGUEZ
Provider First Name:
JOANN
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
I
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:
1912485541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORMIGUEROS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-384-5118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 2 KM 173.4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683-0285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2018

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: 207R00000X , with the licence number:  33910-R , 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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