1043558547 NPI number — CONSULTORIO MEDICO M L O INC

Table of content: (NPI 1043558547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043558547 NPI number — CONSULTORIO MEDICO M L O INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTORIO MEDICO M L O INC
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:
1043558547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142784
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-650-1363
Provider Business Mailing Address Fax Number:
787-650-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAR 129 KM 37 H7 BO HATO ARRIBA-DENKTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-650-1353
Provider Business Practice Location Address Fax Number:
787-650-1353
Provider Enumeration Date:
01/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ORTIZ DE LA CRUZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
LOURDES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-597-6987

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  14416 , 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)