1275693574 NPI number — SERVICIOS MEDICOS PROFESIONALES DOCTOR J. DIAZ CSP

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 1275693574 NPI number — SERVICIOS MEDICOS PROFESIONALES DOCTOR J. DIAZ CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS MEDICOS PROFESIONALES DOCTOR J. DIAZ CSP
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:
1275693574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CENTRO COOP
Provider Second Line Business Mailing Address:
SUITE 5000 BOX 953
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-0953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-0045
Provider Business Mailing Address Fax Number:
787-868-0045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CALLE COLON STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-868-0045
Provider Business Practice Location Address Fax Number:
787-868-0045
Provider Enumeration Date:
12/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ RUIZ
Authorized Official First Name:
JAMIL
Authorized Official Middle Name:
TARECK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-244-7348

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  12986 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12986 . This is a "LOCAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com