1417574997 NPI number — CRECEX LLC

Table of content: (NPI 1417574997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417574997 NPI number — CRECEX LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRECEX LLC
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:
6
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:
1417574997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-5277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-856-8274
Provider Business Mailing Address Fax Number:
787-267-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO BARINAS 500 CARR 335
Provider Second Line Business Practice Location Address:
KM 1.6
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-856-7284
Provider Business Practice Location Address Fax Number:
787-267-1011
Provider Enumeration Date:
06/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ASENCIO
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
ALAMEDA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-930-4363

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038526800 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: ========= , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com