1487626875 NPI number — OTTO A SARRIERA-ROCAFORT MD, MRO

Table of content: (NPI 1447436027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487626875 NPI number — OTTO A SARRIERA-ROCAFORT MD, MRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARRIERA-ROCAFORT
Provider First Name:
OTTO
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MRO
Provider Gender Code:
M

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:
1487626875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19346
Provider Second Line Business Mailing Address:
FDEZ. JUNCOS STA.
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00910-1346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-226-5387
Provider Business Mailing Address Fax Number:
787-793-6538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1534 CALLE 10 SO
Provider Second Line Business Practice Location Address:
CAPARRA TERRACE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-226-5387
Provider Business Practice Location Address Fax Number:
787-793-6538
Provider Enumeration Date:
02/02/2006

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: 208D00000X , with the licence number:  7919 , 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: 80155 . This is a "TRIPLE-S PIN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6220017 . This is a "HUMANA INSURANCE PIN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 062616 . This is a "CRUZ AZUL DE PR PIN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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