1033371935 NPI number — EDEN E & E INC

Table of content: (NPI 1033371935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033371935 NPI number — EDEN E & E INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDEN E & E 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:
LABORATORIO CLINICO EDMARIE
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:
1033371935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1345
Provider Second Line Business Mailing Address:
PMB 293
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00954 1345
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-361-0961
Provider Business Mailing Address Fax Number:
787-869-5656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COMERCIAL JARDINES DE NARANJITO
Provider Second Line Business Practice Location Address:
CARR.164 KM 7.7 BO.ACHIOTE
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-361-0961
Provider Business Practice Location Address Fax Number:
787-799-0828
Provider Enumeration Date:
07/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DE LEON DIAZ
Authorized Official First Name:
EDMARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-361-0961

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  6567 , 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)