1093030330 NPI number — MEDICOS DEL ESTE GRUPO UNIDOS

Table of content: (NPI 1093030330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093030330 NPI number — MEDICOS DEL ESTE GRUPO UNIDOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICOS DEL ESTE GRUPO UNIDOS
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:
1093030330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLA STATION
Provider Second Line Business Mailing Address:
216 VILLA UNIVERSITARIA
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-852-2470
Provider Business Mailing Address Fax Number:
787-285-4165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE JOSE CELSO BARBOSA
Provider Second Line Business Practice Location Address:
SUITE 68
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-2470
Provider Business Practice Location Address Fax Number:
787-285-4165
Provider Enumeration Date:
03/30/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRANCESCHI
Authorized Official First Name:
MARICARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTATOR
Authorized Official Telephone Number:
787-852-2470

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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