1659896959 NPI number — MUNICIPIO DE GUANICA

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 1659896959 NPI number — MUNICIPIO DE GUANICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNICIPIO DE GUANICA
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:
CENTRO DE VACUNACION CDT DE GUANICA
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:
1659896959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUANICA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00653-0785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-821-0402
Provider Business Mailing Address Fax Number:
787-569-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 116 INTERIOR KM 27.7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUANICA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00653-0065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-821-0402
Provider Business Practice Location Address Fax Number:
787-569-4022
Provider Enumeration Date:
08/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SEDA
Authorized Official First Name:
SANTOS
Authorized Official Middle Name:
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
787-821-2777

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1175 . This is a "PUERTO RICO HEALTCARE DEPARTMENT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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