1922368448 NPI number — DR. HOWARD J. WETTERER DUCLERC,CSP

Table of content: (NPI 1922368448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922368448 NPI number — DR. HOWARD J. WETTERER DUCLERC,CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. HOWARD J. WETTERER DUCLERC,CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1922368448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 CALLE SAN GENARO
Provider Second Line Business Mailing Address:
SAGRADO CORAZON
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-342-9228
Provider Business Mailing Address Fax Number:
787-801-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 AVE GENERAL VALERO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-801-3158
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WETTERER
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
JOHM
Authorized Official Title or Position:
PRIMARY OFFICER
Authorized Official Telephone Number:
787-342-9228

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  14536 , 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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