1477781292 NPI number — MEDICAL EPILEPSY CARE PSC

Table of content: (NPI 1477781292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477781292 NPI number — MEDICAL EPILEPSY CARE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EPILEPSY CARE PSC
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:
1477781292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LA VILLA DE TORRIMAR
Provider Second Line Business Mailing Address:
CALLE REY FRANCISCO 332
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-751-2509
Provider Business Mailing Address Fax Number:
787-781-5307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 AVE SAN PATRICIO SUITE 1270
Provider Second Line Business Practice Location Address:
EDF MARAMAR PLAZA
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-751-2509
Provider Business Practice Location Address Fax Number:
787-781-5307
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PITA GARCIA
Authorized Official First Name:
IGNACIO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEDICO
Authorized Official Telephone Number:
787-948-2231

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X , with the licence number:  14,434 , 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: 14,434 . This is a "LIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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