1780985937 NPI number — DR RADAMES ANTONIO MARIN-MEDICINA DE FAMILIA CSP

Table of content: (NPI 1780985937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780985937 NPI number — DR RADAMES ANTONIO MARIN-MEDICINA DE FAMILIA CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR RADAMES ANTONIO MARIN-MEDICINA DE FAMILIA CSP
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:
1780985937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-364-0514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSP DR. TITO MATTEI OFIC.119A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-364-0514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARIN VIEIRA
Authorized Official First Name:
RADAME
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-364-0514

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10758 , 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: 0088624 . This is a "MEDICARE PART B" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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