1639455611 NPI number — INSTITUTO MULTIDISCIPLINARIO Y EDUCATIVO DEL CENTRO

Table of content: (NPI 1639455611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639455611 NPI number — INSTITUTO MULTIDISCIPLINARIO Y EDUCATIVO DEL CENTRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO MULTIDISCIPLINARIO Y EDUCATIVO DEL CENTRO
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:
IMEC
Provider Other Organization Name Type Code:
5
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:
1639455611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6400
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-6400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-263-8108
Provider Business Mailing Address Fax Number:
787-263-8108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE ANTONIO R BARCELO
Provider Second Line Business Practice Location Address:
KM 73.6
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-263-8108
Provider Business Practice Location Address Fax Number:
787-263-8108
Provider Enumeration Date:
10/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
ALBA
Authorized Official Middle Name:
IRIS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-263-8108

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  898 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 898 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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