1912692435 NPI number — VICTOR DANIEL SANOGUET LOPEZ

Table of content: VICTOR DANIEL SANOGUET LOPEZ (NPI 1912692435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912692435 NPI number — VICTOR DANIEL SANOGUET LOPEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANOGUET LOPEZ
Provider First Name:
VICTOR
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
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:
1912692435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 703
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-906-9823
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MANSIONES DE ESPANA MIGUEL DE CERVANTES #214
Provider Second Line Business Practice Location Address:
MIGUEL DE CERVANTES
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-906-9823
Provider Business Practice Location Address Fax Number:
--
Provider Enumeration Date:
04/10/2023

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: 367500000X , with the licence number:  11025641 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119279700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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