1265651889 NPI number — CPP GYN GROUP 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 1265651889 NPI number — CPP GYN GROUP CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPP GYN GROUP 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:
6
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:
1265651889
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:
6429 CARR 2 PMB 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEBRADILLAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00678-6429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-2945
Provider Business Mailing Address Fax Number:
787-882-2945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUEN SAMARITANO HOSPITAL
Provider Second Line Business Practice Location Address:
LEVEL G OFFICE 9
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-2945
Provider Business Practice Location Address Fax Number:
787-882-2945
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POU
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-882-2945

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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