1881818003 NPI number — GRUPO MEDICO FAMILIAR

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 1881818003 NPI number — GRUPO MEDICO FAMILIAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICO FAMILIAR
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:
1881818003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 5 BOX 93480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-9568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-449-8806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC 5 BOX 93480
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-9568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-449-8806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
YADIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
787-449-8806

Provider Taxonomy Codes

  • Taxonomy code: 170100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: J03125 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 994269 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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