1093105256 NPI number — GRUPO MEDICO CAROLINA, LLC

Table of content: (NPI 1093105256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093105256 NPI number — GRUPO MEDICO CAROLINA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICO CAROLINA, 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:
SERVICIOS SALUD MENTAL CAROLINA
Provider Other Organization Name Type Code:
4
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:
1093105256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9067
Provider Second Line Business Mailing Address:
PLAZA CAROLINA STATION
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00988-9067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-752-1979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35-21 CALLE 16
Provider Second Line Business Practice Location Address:
VILLA CAROLINA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-752-1979
Provider Business Practice Location Address Fax Number:
787-998-3656
Provider Enumeration Date:
01/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMES
Authorized Official First Name:
DIOGENES
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PROPRIETOR/MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-550-2467

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)





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