1992725402 NPI number — SERVICIOS DE SALUD PRIMARIOS DE AGUAS BUENAS, CSP

Table of content: ANDY W. LEE DDS (NPI 1952474132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992725402 NPI number — SERVICIOS DE SALUD PRIMARIOS DE AGUAS BUENAS, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS DE SALUD PRIMARIOS DE AGUAS BUENAS, 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:
1992725402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUAS BUENAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00703-1490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LUIS M. RIVERA #105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUAS BUENAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00703-1490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-732-0755
Provider Business Practice Location Address Fax Number:
787-732-2205
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ GOMEZ
Authorized Official First Name:
ALFREDO
Authorized Official Middle Name:
Authorized Official Title or Position:
SOCIO ADMINISTRADOR
Authorized Official Telephone Number:
787-732-0755

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , 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)





Copyright © 2007-2024 www.npivalidator.com