1174566236 NPI number — CENTRO DE PEDIATRIA Y MEDICINA DE FAMILIA DE VILLALBA, CSP

Table of content: (NPI 1174566236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174566236 NPI number — CENTRO DE PEDIATRIA Y MEDICINA DE FAMILIA DE VILLALBA, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE PEDIATRIA Y MEDICINA DE FAMILIA DE VILLALBA, CSP
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:
1174566236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6004
Provider Second Line Business Mailing Address:
MSC 247
Provider Business Mailing Address City Name:
VILLALBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00766-6004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-847-4667
Provider Business Mailing Address Fax Number:
787-847-4868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO TIERRA SANTA
Provider Second Line Business Practice Location Address:
KM 58.2 CARR 149
Provider Business Practice Location Address City Name:
VILLALBA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-847-4667
Provider Business Practice Location Address Fax Number:
787-847-4868
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ AYBAR
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-847-4667

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  008564 , 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)





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