1366550287 NPI number — INSTITUTO METROPOLITANO DE MEDICINA FISICA

Table of content: (NPI 1366550287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366550287 NPI number — INSTITUTO METROPOLITANO DE MEDICINA FISICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO METROPOLITANO DE MEDICINA FISICA
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:
1366550287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
J16 CALLE 2
Provider Second Line Business Mailing Address:
STE 110 EDIF MEDICO HNAS DAVILA
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959-5041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-775-2685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1789 CARR 21
Provider Second Line Business Practice Location Address:
STE 405 TORRE DEL METROPOLITANO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-775-2685
Provider Business Practice Location Address Fax Number:
787-277-0362
Provider Enumeration Date:
08/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AGUOYO
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN & PM&R
Authorized Official Telephone Number:
787-775-2685

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  11346 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 9894 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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