1780687947 NPI number — DR. WANDA MIGDALIA BELTRAN VIRELLA M.D.

Table of content: DR. WANDA MIGDALIA BELTRAN VIRELLA M.D. (NPI 1780687947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780687947 NPI number — DR. WANDA MIGDALIA BELTRAN VIRELLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELTRAN VIRELLA
Provider First Name:
WANDA
Provider Middle Name:
MIGDALIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1780687947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364867
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:
00936-4867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-787-0310
Provider Business Mailing Address Fax Number:
787-798-1275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 402 BAYAMON MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-4455
Provider Business Practice Location Address Fax Number:
787-859-4454
Provider Enumeration Date:
05/23/2005

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: 207R00000X , with the licence number:  8167 , 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)





Copyright © 2007-2024 www.npivalidator.com