1124269709 NPI number — SALUTARIS DIALYSIS AND NEPHROLOGY CENTER CORPORATION

Table of content: MRS. TONIA NMN ALLEN LRRT (NPI 1659080166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124269709 NPI number — SALUTARIS DIALYSIS AND NEPHROLOGY CENTER CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUTARIS DIALYSIS AND NEPHROLOGY CENTER CORPORATION
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1124269709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1479 AVE ASHFORD
Provider Second Line Business Mailing Address:
APT 420
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-1583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-0505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 172 HOSPITAL SAN JUAN BAUTISTA
Provider Second Line Business Practice Location Address:
TERCER PISO
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-0550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
HERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-653-0505

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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