1275759235 NPI number — CENTRO DE VACUNACION DR. FRANCISCO DE LA TORRE

Table of content: (NPI 1275759235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275759235 NPI number — CENTRO DE VACUNACION DR. FRANCISCO DE LA TORRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE VACUNACION DR. FRANCISCO DE LA TORRE
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:
1275759235
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:
URB RIO HONDO 2
Provider Second Line Business Mailing Address:
AJ1 CALLE RIO JAJOME
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-799-6868
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 828 KM 0.1
Provider Second Line Business Practice Location Address:
BO. PINAS
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-799-6868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA TORRE
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
Authorized Official Title or Position:
PEDIATRICIAN
Authorized Official Telephone Number:
787-799-6868

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  3165 , 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: 10579 . This is a "TRIPLE-S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9610134 . This is a "HUMANA HEALTH PLANS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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