1477785954 NPI number — CENTRO DE NUTRICION VILLA LOS SANTOS

Table of content: (NPI 1477785954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477785954 NPI number — CENTRO DE NUTRICION VILLA LOS SANTOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE NUTRICION VILLA LOS SANTOS
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:
CDT VILLA LOS SANTOS
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:
1477785954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
V1 CALLE 16
Provider Second Line Business Mailing Address:
URB VILLA LOS SANTOS
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-3112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-879-1585
Provider Business Mailing Address Fax Number:
787-880-1143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
V1 CALLE 16
Provider Second Line Business Practice Location Address:
URB VILLA LOS SANTOS
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-879-1585
Provider Business Practice Location Address Fax Number:
787-879-4315
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRADORA
Authorized Official Telephone Number:
787-817-3144

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X , with the licence number:  115 , 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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