1184831398 NPI number — ATLANTIS HEALTH CARE GROUP PUERTO RICO 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 1184831398 NPI number — ATLANTIS HEALTH CARE GROUP PUERTO RICO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIS HEALTH CARE GROUP PUERTO RICO 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:
RENAL CENTER OF GUAYNABO
Provider Other Organization Name Type Code:
3
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:
1184831398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1350
Provider Second Line Business Mailing Address:
SAINT JUST STATION
Provider Business Mailing Address City Name:
SAINT JUST
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00978-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-7979
Provider Business Mailing Address Fax Number:
787-292-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GUAYNABO MEDICAL MALL # 140
Provider Second Line Business Practice Location Address:
AVENIDA LAS CUMBRE
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-292-7979
Provider Business Practice Location Address Fax Number:
787-292-7999
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ACEVEDO
Authorized Official First Name:
INGRID
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP & CFO
Authorized Official Telephone Number:
787-292-7979

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  LIC # 15 CNC 07-227 , 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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