1649485657 NPI number — SOC DRES ATILANO LEON, JOSE A MORALES, EDGAR ECHEVARRIA

Table of content: (NPI 1649485657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649485657 NPI number — SOC DRES ATILANO LEON, JOSE A MORALES, EDGAR ECHEVARRIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOC DRES ATILANO LEON, JOSE A MORALES, EDGAR ECHEVARRIA
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:
SOC CIRUGIA ORAL Y MAXILOFACIAL
Provider Other Organization Name Type Code:
3
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:
1649485657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29736
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:
00929-0736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-755-4347
Provider Business Mailing Address Fax Number:
787-283-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 CALLE NAPOLES STE 208
Provider Second Line Business Practice Location Address:
CONCORDIA GARDENS SHOPPING CTR
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-755-4347
Provider Business Practice Location Address Fax Number:
787-283-7440
Provider Enumeration Date:
05/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTANEZ
Authorized Official First Name:
EMMA
Authorized Official Middle Name:
GISELA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-374-1181

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , 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)

  • Identifier: 004-0826CI . This is a "SSS PROVIDER NOMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 067099 . This is a "LA CRUZ AZUL PROVIDER NOM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4390 . This is a "PMC PROVIDER NOMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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