1518338193 NPI number — METROPOLITAN OTORHINOLARYNGOLOGY GROUP, CSP

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 1518338193 NPI number — METROPOLITAN OTORHINOLARYNGOLOGY GROUP, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN OTORHINOLARYNGOLOGY GROUP, CSP
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:
1518338193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LAS FLORES MONTEHIEDRA
Provider Second Line Business Mailing Address:
BOX 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:
787-781-0644
Provider Business Mailing Address Fax Number:
787-781-5923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1785 CARR 21
Provider Second Line Business Practice Location Address:
COND. TORRE DEL METROPOLITAN OFICINA 309
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:
787-781-0644
Provider Business Practice Location Address Fax Number:
787-781-5923
Provider Enumeration Date:
10/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MELERO GIGANTE
Authorized Official First Name:
GUSTAVO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-781-0644

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  13177 , 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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