1083946412 NPI number — SALA DE EMERGENCIA SHALOM, 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 1083946412 NPI number — SALA DE EMERGENCIA SHALOM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALA DE EMERGENCIA SHALOM, 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:
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:
1083946412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 903
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEBRADILLAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00678-0903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-895-0914
Provider Business Mailing Address Fax Number:
787-895-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 KM 101 6
Provider Second Line Business Practice Location Address:
TERRANOVA MARGINAL DEL PARQUE
Provider Business Practice Location Address City Name:
QUEBRADILLAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-895-0914
Provider Business Practice Location Address Fax Number:
787-895-4999
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PAGAN ROMERO
Authorized Official First Name:
ANIBAL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-895-0914

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  13 , 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)

  • Identifier: 13 . This is a "EMERGENCY CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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