1982734604 NPI number — PROGRAMA SIDA DE SAN JUAN

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 1982734604 NPI number — PROGRAMA SIDA DE SAN JUAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRAMA SIDA DE SAN JUAN
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:
1982734604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1306 AVE FERNANDEZ JUNCOS
Provider Second Line Business Mailing Address:
STOP 19
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00909-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-722-5470
Provider Business Mailing Address Fax Number:
787-724-5104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1306 AVE FERNANDEZ JUNCOS
Provider Second Line Business Practice Location Address:
STOP 19
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00909-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-722-5470
Provider Business Practice Location Address Fax Number:
787-724-5104
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SORRENTINI
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTO
Authorized Official Telephone Number:
787-977-0540

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4023064 . This is a "NABP" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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