1912980301 NPI number — DR. LILLIAM CARABALLO LEMELL DPM, MPH

Table of content: DR. LILLIAM CARABALLO LEMELL DPM, MPH (NPI 1912980301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912980301 NPI number — DR. LILLIAM CARABALLO LEMELL DPM, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMELL
Provider First Name:
LILLIAM
Provider Middle Name:
CARABALLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIQUEZ
Provider Other First Name:
LILLIAM
Provider Other Middle Name:
CARABALLO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM, MPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912980301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-0677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-841-2228
Provider Business Mailing Address Fax Number:
787-841-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE SAN CRISTOBAL
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-841-2228
Provider Business Practice Location Address Fax Number:
787-841-2220
Provider Enumeration Date:
11/21/2005

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: 213E00000X , with the licence number:  000030 , 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)





Copyright © 2007-2024 www.npivalidator.com