1467879445 NPI number — SERVICIOS DE SALUD LA MORENITA INC

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 1467879445 NPI number — SERVICIOS DE SALUD LA MORENITA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS DE SALUD LA MORENITA INC
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:
6
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:
1467879445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 VIA CARACOLES
Provider Second Line Business Mailing Address:
URB. CAMINO DEL MAR
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-5050
Provider Business Mailing Address Fax Number:
787-785-5050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR 174 KM 10.2
Provider Second Line Business Practice Location Address:
BARRIO GUARAGUAO
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-785-5050
Provider Business Practice Location Address Fax Number:
787-785-5050
Provider Enumeration Date:
03/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
EFRAIN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-637-4416

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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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