1174705040 NPI number — CORPORACION PUERTORRIQUENA DE SALUD INTEGRAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174705040 NPI number — CORPORACION PUERTORRIQUENA DE SALUD INTEGRAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORACION PUERTORRIQUENA DE SALUD INTEGRAL
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:
CORPUSAD
Provider Other Organization Name Type Code:
4
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:
1174705040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 CALLE MCKINLEY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-637-0822
Provider Business Mailing Address Fax Number:
787-650-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 CALLE DR CUETO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTUADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00641-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-637-0822
Provider Business Practice Location Address Fax Number:
787-650-2835
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABREU
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
YAMIL
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
787-547-1382

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  16579 , 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)





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