1194575316 NPI number — PUERTO RICO CASE MANEGEMENT CORP

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 1194575316 NPI number — PUERTO RICO CASE MANEGEMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUERTO RICO CASE MANEGEMENT CORP
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:
1194575316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 CARR 169 APT 1006 BALCONES DE GUAYNABO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-358-0381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 AVENIDA LAS CUMBRES GUAYNABO MEDICAL MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-358-0381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BENITEZ
Authorized Official First Name:
GISSELLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-358-0381

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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