1639164262 NPI number — GRUPO MEDICO DEL NORESTE

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 1639164262 NPI number — GRUPO MEDICO DEL NORESTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICO DEL NORESTE
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:
1639164262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41A CALLE ORQUIDEA
Provider Second Line Business Mailing Address:
LOIZA VALLEY
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-256-5659
Provider Business Mailing Address Fax Number:
787-256-5659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41A CALLE ORQUIDEA
Provider Second Line Business Practice Location Address:
LOIZA VALLEY
Provider Business Practice Location Address City Name:
CANOVANAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00729-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-256-5659
Provider Business Practice Location Address Fax Number:
787-256-5659
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BORDET
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-256-5659

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com