1477945533 NPI number — RETINA CENTER OF PUERTO RICO P S C

Table of content: (NPI 1477945533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477945533 NPI number — RETINA CENTER OF PUERTO RICO P S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA CENTER OF PUERTO RICO P S C
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:
1477945533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARR 693
Provider Second Line Business Mailing Address:
PMB 152
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646-6706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-1900
Provider Business Mailing Address Fax Number:
787-854-1918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARGINAL CARRETERA NO 2, KM 47 7
Provider Second Line Business Practice Location Address:
TORRE MEDICA 2 SUITE 260
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-1900
Provider Business Practice Location Address Fax Number:
787-854-1918
Provider Enumeration Date:
02/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AL-ATTAR
Authorized Official First Name:
LUMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-854-1900

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME87876 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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