1245566447 NPI number — CDT DE VEGA BAJA

Table of content: (NPI 1245566447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245566447 NPI number — CDT DE VEGA BAJA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDT DE VEGA BAJA
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:
MEDICAL EMERGENCY GROUP JRJ, CSP
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:
1245566447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00726
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-745-0708
Provider Business Mailing Address Fax Number:
787-744-8065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB VILLA PINARES
Provider Second Line Business Practice Location Address:
CALLE PASEO VILLA PINARES 81
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PUERTO RICO
Provider Business Practice Location Address Postal Code:
00693
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
787-858-2416
Provider Business Practice Location Address Fax Number:
787-744-8065
Provider Enumeration Date:
10/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-745-0708

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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