1407214604 NPI number — RESTAURANTE UNIVERSAL DEL PUEBLO

Table of content: G BYRON HODGE JR. M.D. (NPI 1700879913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407214604 NPI number — RESTAURANTE UNIVERSAL DEL PUEBLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTAURANTE UNIVERSAL DEL PUEBLO
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:
1407214604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2072 OPA LOCKA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPA LOCKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33054-4228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-487-8104
Provider Business Mailing Address Fax Number:
786-592-1504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2072 OPA LOCKA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPA LOCKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33054-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-487-8104
Provider Business Practice Location Address Fax Number:
786-592-1504
Provider Enumeration Date:
02/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
LUZ
Authorized Official Middle Name:
EDITH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-487-8104

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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