1447451232 NPI number — METROPOLITAN OTORINOLARINGOLOGY GROUP

Table of content: (NPI 1447451232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447451232 NPI number — METROPOLITAN OTORINOLARINGOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN OTORINOLARINGOLOGY GROUP
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:
1447451232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. FLORES MONTEHIEDRA
Provider Second Line Business Mailing Address:
BLVD. DE LA MONTANA APT 643
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-706-1315
Provider Business Mailing Address Fax Number:
787-781-5923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL METROPOLITANO SUITE 206
Provider Second Line Business Practice Location Address:
CARR. 21 #1785 LAS LOMAS
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-706-1315
Provider Business Practice Location Address Fax Number:
787-781-5923
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELERO
Authorized Official First Name:
GUSATVO
Authorized Official Middle Name:
ANDRES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-706-1315

Provider Taxonomy Codes

  • Taxonomy code: 207YS0012X , with the licence number:  13177 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 9210029 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9909 . This is a "INTERNATIONAL MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9210029 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 250069 . This is a "PREFERRED HELATH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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