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

Table of content: (NPI 1407244759)

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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