1053926451 NPI number — LOS PINOS MEDICAL CENTER LLC

Table of content: MR. MARTIN DENNIS HAIRSTON RN (NPI 1285845230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053926451 NPI number — LOS PINOS MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS PINOS MEDICAL CENTER LLC
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:
1053926451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB SABANERA
Provider Second Line Business Mailing Address:
CAMINO DE AGUIRRE #542
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-315-8801
Provider Business Mailing Address Fax Number:
844-858-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO SANTANA ZONA INDUSTRIAL
Provider Second Line Business Practice Location Address:
CARR #2 KM 67.7
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-644-7043
Provider Business Practice Location Address Fax Number:
844-858-3125
Provider Enumeration Date:
09/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIVERA RIESTRA
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
787-315-8801

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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