Provider Demographics
NPI:1871578245
Name:PLAZA, PRISCILLA (MD)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name: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 1:5556 CALLE LOBINA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1358
Mailing Address - Country:US
Mailing Address - Phone:787-840-7234
Mailing Address - Fax:787-840-7234
Practice Address - Street 1:AMALIA MARIN 5556 LOBINA ST.
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-840-7234
Practice Address - Fax:787-840-7234
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14493146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH80200Medicare UPIN