1104043686 NPI number — CENTRO MEDICO DEL TURABO INC

Table of content: (NPI 1104043686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104043686 NPI number — CENTRO MEDICO DEL TURABO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO DEL TURABO 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:
GRUPO MEDICINA NUCLEAR
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:
1104043686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-620-4307
Provider Business Mailing Address Fax Number:
787-620-4307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIMA SAN PABLO CAGUAS SOTANO
Provider Second Line Business Practice Location Address:
AVE LUIS MUNOZ MARIN
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-620-4307
Provider Business Practice Location Address Fax Number:
787-653-2217
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-653-3434

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X , with the licence number:  9192 , 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)

  • Identifier: INDIVIDUAL NPI . This is a "1780605345" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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