1548680705 NPI number — CLINICA DE MANEJO DEL DOLOR DR JOSE R OLLER LOPEZ CSP

Table of content: (NPI 1548680705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548680705 NPI number — CLINICA DE MANEJO DEL DOLOR DR JOSE R OLLER LOPEZ CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE MANEJO DEL DOLOR DR JOSE R OLLER LOPEZ 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:
1548680705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
558 CALLE BADAJOZ
Provider Second Line Business Mailing Address:
MANSIONES CIUDAD JARDIN
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-464-6369
Provider Business Mailing Address Fax Number:
787-735-7613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 167 MARGINAL B4
Provider Second Line Business Practice Location Address:
FORREST HILLS
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-464-6369
Provider Business Practice Location Address Fax Number:
787-735-7613
Provider Enumeration Date:
04/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
OLLER LOPEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-464-6369

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  13903 , 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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