1023031499 NPI number — CONSULTA MEDICA OCHOA

Table of content: (NPI 1023031499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023031499 NPI number — CONSULTA MEDICA OCHOA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTA MEDICA OCHOA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1023031499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CALLE RICARDI
Provider Second Line Business Mailing Address:
PALACIOS REALES
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953-4917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-799-9800
Provider Business Mailing Address Fax Number:
787-799-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROAD 167 KM 14.8
Provider Second Line Business Practice Location Address:
BO BUENA VISTA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-799-9800
Provider Business Practice Location Address Fax Number:
787-799-9800
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
787-799-9800

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  14396 , 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)