1225013402 NPI number — INSTITUTO DE CUIDADO DEL SENO

Table of content: (NPI 1225013402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225013402 NPI number — INSTITUTO DE CUIDADO DEL SENO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO DE CUIDADO DEL SENO
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:
1225013402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BAYAMON MEDICAL PLZ
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-641-0209
Provider Business Mailing Address Fax Number:
787-779-8178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYAMON MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-0209
Provider Business Practice Location Address Fax Number:
787-779-8178
Provider Enumeration Date:
12/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
CARLOS
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
787-641-0209

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2013IN . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: RX76715 . This is a "UIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061658 . This is a "CAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7605 . This is a "IMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9590095 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PE4737 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".




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