1194318519 NPI number — KCN-NUTRICION CON BIENESTAR LLC

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 1194318519 NPI number — KCN-NUTRICION CON BIENESTAR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KCN-NUTRICION CON BIENESTAR LLC
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:
1194318519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUAS BUENAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00703-0463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-469-4784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO CANABON SECTOR LA UNION
Provider Second Line Business Practice Location Address:
CARR 156 KM 55.3
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-0070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-469-4784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CLAUDIO NAVARRO
Authorized Official First Name:
KARILYN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRADORA
Authorized Official Telephone Number:
787-469-4784

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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