1184658775 NPI number — CUIDADO CASERO MAYAGUEZ, 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 1184658775 NPI number — CUIDADO CASERO MAYAGUEZ, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUIDADO CASERO MAYAGUEZ, 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:
1184658775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 AVE DE DIEGO
Provider Second Line Business Mailing Address:
PUERTO NUEVO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00920-3723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-620-5577
Provider Business Mailing Address Fax Number:
787-620-5582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 AVE HOSTOS
Provider Second Line Business Practice Location Address:
MEDICAL CENTER PLAZA OFFICE 310
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00682-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-833-1985
Provider Business Practice Location Address Fax Number:
787-831-2262
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
817-310-1100

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  43153 , 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)