1407244759 NPI number — PROGRESSIVE HEALTHCARE PARTNERS L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407244759 NPI number — PROGRESSIVE HEALTHCARE PARTNERS L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE HEALTHCARE PARTNERS L.L.C.
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:
1407244759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1494 ROOSEVELT AVENUE SUITE 101
Provider Second Line Business Mailing Address:
CAPARRA HEIGHTS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-645-0875
Provider Business Mailing Address Fax Number:
787-273-1452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1494 ROOSEVELT AVE. SUITE 101
Provider Second Line Business Practice Location Address:
CAPARRA HEIGHTS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-645-0875
Provider Business Practice Location Address Fax Number:
787-273-1452
Provider Enumeration Date:
01/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ARROYO ROMEU
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-645-0875

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  0094 , 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: 0094 . This is a "PODIATRIST LICENSE OF PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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