1093347015 NPI number — CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.

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 1093347015 NPI number — CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBBEAN INFECTOLOGY CONSULTING GROUP, L.L.C.
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:
1093347015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 712
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCEDITA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00715-0712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-987-8050
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2053 PONCE BYPASS
Provider Second Line Business Practice Location Address:
CENTRO CARIBE BLDG. SUITE 205
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-987-8050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LUGO VELEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
JORGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-688-7327

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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