1487716338 NPI number — EQUIPO MEDICO DE GURABO, CORP.

Table of content: (NPI 1487716338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487716338 NPI number — EQUIPO MEDICO DE GURABO, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EQUIPO MEDICO DE GURABO, CORP.
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:
1487716338
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:
7 ST. EL VIVERO F2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-2338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-737-0840
Provider Business Mailing Address Fax Number:
787-737-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7ST. EL VIVERO F2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-737-0840
Provider Business Practice Location Address Fax Number:
787-737-6088
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANCELADO BOAVITA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
RAUL
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
787-391-0099

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  97337 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X , with the licence number: RFO01356 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 50398 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 55220 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: EQUIPOME01 EQ2005 . This is a "INMEDIATA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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