1295923720 NPI number — SOMNOS CORP

Table of content: (NPI 1295923720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295923720 NPI number — SOMNOS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMNOS 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:
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:
1295923720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 CALLE CASTILLA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-290-5577
Provider Business Mailing Address Fax Number:
787-848-6644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 AVE TITO CASTRO
Provider Second Line Business Practice Location Address:
TORRE MEDICA SAN LUCAS SUITE 701
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-290-5577
Provider Business Practice Location Address Fax Number:
787-848-6644
Provider Enumeration Date:
10/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAHED
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-290-5577

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  13251 , 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: 13251 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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