1457599110 NPI number — PEDRO J NEVAREZ BRUNO

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 1457599110 NPI number — PEDRO J NEVAREZ BRUNO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDRO J NEVAREZ BRUNO
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:
NEVAREZ AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1457599110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/01/2009
NPI Reactivation Date:
05/21/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3061
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-3061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-642-6272
Provider Business Mailing Address Fax Number:
787-785-6097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB.CIBUCO
Provider Second Line Business Practice Location Address:
CALLE 1 C-13
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-451-2727
Provider Business Practice Location Address Fax Number:
787-785-6097
Provider Enumeration Date:
02/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NEVAREZ
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
JAVIER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-642-6272

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC-AMB575 , 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)





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