1982082061 NPI number — AIDA NANCY SISCO RDN, LND, DYSC, DEPR

Table of content: AIDA NANCY SISCO RDN, LND, DYSC, DEPR (NPI 1982082061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982082061 NPI number — AIDA NANCY SISCO RDN, LND, DYSC, DEPR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SISCO
Provider First Name:
AIDA
Provider Middle Name:
NANCY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN, LND, DYSC, DEPR
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:
1982082061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 CALLE ZIRCONIA
Provider Second Line Business Mailing Address:
URB.LAMELA
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-2378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-242-2193
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 112 KM 1.4 INT
Provider Second Line Business Practice Location Address:
AVE AGUSTIN RAMOS CALERO HOSPITAL CIMA DE ISABELA
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-0979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-242-2835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2015

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: 133N00000X , with the licence number:  1612 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 1019815 , 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)