1689619660 NPI number — CENTRO DE SERVICIOS MEDICOS DE PENA POBRE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689619660 NPI number — CENTRO DE SERVICIOS MEDICOS DE PENA POBRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE SERVICIOS MEDICOS DE PENA POBRE
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:
CENTRO DE SERVICIOS MEDICOS DE MUNICIPIO DE NAGUABO
Provider Other Organization Name Type Code:
4
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:
1689619660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STREET 31
Provider Second Line Business Mailing Address:
192
Provider Business Mailing Address City Name:
NAGUABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-874-3037
Provider Business Mailing Address Fax Number:
787-874-3037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET 31
Provider Second Line Business Practice Location Address:
192
Provider Business Practice Location Address City Name:
NAGUABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-874-3037
Provider Business Practice Location Address Fax Number:
787-874-3037
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POMALES
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-874-3037

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , with the licence number:  30673 , 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)

  • Identifier: 201648 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6701184 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9001119 . This is a "CRUZ AZUL DE PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00409 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2991-1 . This is a "PROSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 89681 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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