1376869412 NPI number — PEVO PODIATRIC CORP

Table of content: (NPI 1376869412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376869412 NPI number — PEVO PODIATRIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEVO PODIATRIC CORP
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:
1376869412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEGA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00692-0631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-883-4567
Provider Business Mailing Address Fax Number:
787-883-4567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO GRAN CARIBE CARRETERA #2 KM 29.7
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-883-4567
Provider Business Practice Location Address Fax Number:
787-883-4567
Provider Enumeration Date:
04/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ALBELO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
787-871-1325

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  083 , 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)





Copyright © 2007-2024 www.npivalidator.com