1003189994 NPI number — PUERTO RICO COMMUNITY NETWORK FOR CLINICAL RESEARCH ON AIDS, INC.

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 1003189994 NPI number — PUERTO RICO COMMUNITY NETWORK FOR CLINICAL RESEARCH ON AIDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUERTO RICO COMMUNITY NETWORK FOR CLINICAL RESEARCH ON AIDS, INC.
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:
6
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:
1003189994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1162 CALLE BRUMBAUGH
Provider Second Line Business Mailing Address:
URB GARCIA UBARRI
Provider Business Mailing Address City Name:
RIO PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00925-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-773-0464
Provider Business Mailing Address Fax Number:
787-294-1569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1162 CALLE BRUMBAUGH
Provider Second Line Business Practice Location Address:
URB GARCIA UBARRI
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-773-0464
Provider Business Practice Location Address Fax Number:
787-294-1569
Provider Enumeration Date:
02/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ROSAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-773-0464

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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