1518126630 NPI number — AIROJEN CENTER INC

Table of content: (NPI 1518126630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518126630 NPI number — AIROJEN CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIROJEN CENTER 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:
COMPREHENSIVE PSYCHIATRIC CENTER
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:
1518126630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9735 EAST FERN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-651-2332
Provider Business Mailing Address Fax Number:
305-651-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9735 EAST FERN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-651-2332
Provider Business Practice Location Address Fax Number:
305-651-1173
Provider Enumeration Date:
06/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
DE JESUS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
305-238-5121

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 118266900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com