1306801550 NPI number — DR. ANOUK MICHELLE UNDERWOOD O.D.

Table of content: DR. ANOUK MICHELLE UNDERWOOD O.D. (NPI 1306801550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306801550 NPI number — DR. ANOUK MICHELLE UNDERWOOD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERWOOD
Provider First Name:
ANOUK
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1306801550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 AVE LAS CUMBERS
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969-4836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-513-4187
Provider Business Mailing Address Fax Number:
787-258-8225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 AVE LAS CUMBERS
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-4836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-513-4187
Provider Business Practice Location Address Fax Number:
787-258-8225
Provider Enumeration Date:
04/19/2006

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: 152W00000X , with the licence number:  600 , 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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