1588919294 NPI number — CLINICA DE SALUD DEL ESTE, CORP.

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 1588919294 NPI number — CLINICA DE SALUD DEL ESTE, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE SALUD DEL ESTE, 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:
1588919294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 CALLE IRMA RUIZ PAGAN
Provider Second Line Business Mailing Address:
URB BRISAS DEL MAR
Provider Business Mailing Address City Name:
LUQUILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-889-4401
Provider Business Mailing Address Fax Number:
787-355-7888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 CALLE IRMA RUIZ PAGAN
Provider Second Line Business Practice Location Address:
URB. BRISAS DEL MAR
Provider Business Practice Location Address City Name:
LUQUILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-889-4401
Provider Business Practice Location Address Fax Number:
787-355-7888
Provider Enumeration Date:
07/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-409-4304

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , 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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