1013309442 NPI number — PHYSICIANS AT HOME

Table of content: (NPI 1013309442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013309442 NPI number — PHYSICIANS AT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS AT HOME
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:
MD AT HOME
Provider Other Organization Name Type Code:
5
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:
1013309442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16034 BOLT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729-3801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-479-6620
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BLVD DE LA MONTANA
Provider Second Line Business Practice Location Address:
APT 655
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-7027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-479-6620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DE GRACIA
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-479-6620

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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