1437120979 NPI number — JUAN R DIAZ TROCHE CIRUJANOS CSP

Table of content: (NPI 1437120979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437120979 NPI number — JUAN R DIAZ TROCHE CIRUJANOS CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUAN R DIAZ TROCHE CIRUJANOS CSP
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:
1437120979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-2520
Provider Business Mailing Address Fax Number:
787-833-6730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 CALLE PABLO MAIZ
Provider Second Line Business Practice Location Address:
BO BARCELONA
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-2520
Provider Business Practice Location Address Fax Number:
787-833-6730
Provider Enumeration Date:
02/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIAZ TROCHE
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENTE ADMINISTINDO
Authorized Official Telephone Number:
787-834-2520

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  4677 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 4610 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 11067 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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