Provider Demographics
NPI:1760593917
Name:BANCHS-PLAZA, MARIA LOURDES (MD)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:LOURDES
Last Name:BANCHS-PLAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 CALLE PELTADA
Mailing Address - Street 2:JARDINES DEL CARIBE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3524
Mailing Address - Country:US
Mailing Address - Phone:787-259-7352
Mailing Address - Fax:
Practice Address - Street 1:4981 CALLE PELTADA
Practice Address - Street 2:JARDINES DEL CARIBE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3524
Practice Address - Country:US
Practice Address - Phone:787-259-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH57064Medicare UPIN
PR84115Medicare ID - Type Unspecified