1437152964 NPI number — DR. SURILO I ACOSTA CADENA M.D.

Table of content: DR. SURILO I ACOSTA CADENA M.D. (NPI 1437152964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437152964 NPI number — DR. SURILO I ACOSTA CADENA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACOSTA CADENA
Provider First Name:
SURILO
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1437152964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51526
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-2694
Provider Business Mailing Address Fax Number:
787-787-3109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ZA1 CALLE 36
Provider Second Line Business Practice Location Address:
URB. RIVERVIEW
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-785-2694
Provider Business Practice Location Address Fax Number:
787-787-3109
Provider Enumeration Date:
05/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  6413 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 6413 , 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: 068311 . This is a "CRUZ AZUL PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 500403E . This is a "MMM PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 27740AC . This is a "SSS PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2890 . This is a "IMC PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9500033 . This is a "HUMANA PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".