1477588333 NPI number — INSTITUTO DE DIAGNOSTICO VASCULAR INC

Table of content: (NPI 1477588333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477588333 NPI number — INSTITUTO DE DIAGNOSTICO VASCULAR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO DE DIAGNOSTICO VASCULAR 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:
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:
1477588333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6684
Provider Second Line Business Mailing Address:
MARINA STATION
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-6684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-833-5557
Provider Business Mailing Address Fax Number:
787-265-3711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. #2 AVE. HOSTOS # 410
Provider Second Line Business Practice Location Address:
CENTRO MEDICO 1ER PISO
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00681-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-833-5557
Provider Business Practice Location Address Fax Number:
787-265-3711
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA RINALDI
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
FELIX
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-831-1607

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  5510 , 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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