1427667906 NPI number — NORTHWESTERN RENAL CARE PSC

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 1427667906 NPI number — NORTHWESTERN RENAL CARE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWESTERN RENAL CARE PSC
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:
1427667906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 61 BOX 5400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-9534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-639-0557
Provider Business Mailing Address Fax Number:
787-877-3516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO WESTERN PLAZA, OFICINA 10
Provider Second Line Business Practice Location Address:
AVE. SEVERIANO CUEVAS 18, CARR 460 KM 1.2 INT
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-639-0557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO HERNANDEZ
Authorized Official First Name:
ELVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
939-639-0557

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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