1336419050 NPI number — CENTRO MEDICO BOURNIGAL, S.A

Table of content: (NPI 1336419050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336419050 NPI number — CENTRO MEDICO BOURNIGAL, S.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO BOURNIGAL, S.A
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:
1336419050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BM: 0300095, 8400 NW 25TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-931-1717
Provider Business Mailing Address Fax Number:
407-931-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ANTERA MOTA S/N APARTADO POSTAL NO.25
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUERTO PLATA
Provider Business Practice Location Address State Name:
DOMINCAN REPUBLIC
Provider Business Practice Location Address Postal Code:
NONE
Provider Business Practice Location Address Country Code:
DO
Provider Business Practice Location Address Telephone Number:
809-586-2342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENA
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
407-931-1717

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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