1972800530 NPI number — E C BOUTIQUE CORP

Table of content: (NPI 1972800530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972800530 NPI number — E C BOUTIQUE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E C BOUTIQUE CORP
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:
EYE CENTER BOUTIQUE
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:
1972800530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 PARQUE MEDICI
Provider Second Line Business Mailing Address:
URB PASEO DEL PARQUE
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-768-6666
Provider Business Mailing Address Fax Number:
787-769-6666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AVE FRAGOSO SUITE 108
Provider Second Line Business Practice Location Address:
PLAZA CAROLINA MALL
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-768-6666
Provider Business Practice Location Address Fax Number:
787-769-6666
Provider Enumeration Date:
02/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SALIB
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-768-6666

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  135 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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