1548651417 NPI number — PONTEZUELA GROUP PSC

Table of content: (NPI 1548651417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548651417 NPI number — PONTEZUELA GROUP PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PONTEZUELA GROUP 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:
1548651417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38095
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00937-1095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-757-2347
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 AVE. JOSE TONY SANTANA
Provider Second Line Business Practice Location Address:
EDIF 1 LOCAL C
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-2347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AYALA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-964-7184

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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