1932162955 NPI number — NELLY REYES GONZALEZ RPT

Table of content: NELLY REYES GONZALEZ RPT (NPI 1932162955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932162955 NPI number — NELLY REYES GONZALEZ RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES GONZALEZ
Provider First Name:
NELLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
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:
1932162955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363001
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:
00936-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-4151
Provider Business Mailing Address Fax Number:
787-746-8551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AB5 CALLE NEBRASKA
Provider Second Line Business Practice Location Address:
URB. CAGUAS NORTE
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-704-0421
Provider Business Practice Location Address Fax Number:
787-746-8551
Provider Enumeration Date:
04/10/2006

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: 225100000X , with the licence number:  624 , 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: 50483 . This is a "PMC MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 825693 . This is a "MEDICARE MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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