1083630156 NPI number — HECTOR J GUERRA

Table of content: (NPI 1083630156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083630156 NPI number — HECTOR J GUERRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HECTOR J GUERRA
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:
CLINICAL SUPPORT GROUP INC
Provider Other Organization Name Type Code:
3
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:
1083630156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1432 CALLE BARRACUDA
Provider Second Line Business Mailing Address:
BAHIA VISTAMAR
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00983-1451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-5501
Provider Business Mailing Address Fax Number:
787-768-8094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1432 CALLE BARRACUDA
Provider Second Line Business Practice Location Address:
BAHIA VISTAMAR
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-768-5501
Provider Business Practice Location Address Fax Number:
787-768-8094
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSCALLEDA
Authorized Official First Name:
ALICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
787-768-5501

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 9140 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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