1669559803 NPI number — ANGEL LUIS COMULADA

Table of content: ANGEL LUIS COMULADA (NPI 1669559803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669559803 NPI number — ANGEL LUIS COMULADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMULADA
Provider First Name:
ANGEL
Provider Middle Name:
LUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1669559803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52192
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-2192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-269-6590
Provider Business Mailing Address Fax Number:
787-269-6599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MANUEL F. ROSSI ESQ ISABEL II
Provider Second Line Business Practice Location Address:
BAYAMON HEALTH CENTER SEGUNDO PISO
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-269-6590
Provider Business Practice Location Address Fax Number:
787-269-6599
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  12569 , 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)