1679638290 NPI number — GRUPO MEDICO LOIZA

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 1679638290 NPI number — GRUPO MEDICO LOIZA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICO LOIZA
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:
6
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:
1679638290
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 7709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-7709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-644-6120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 LUIS MUNOZ MARIN AVE.
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-745-0000
Provider Business Practice Location Address Fax Number:
787-745-1314
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRIAS
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENTES
Authorized Official Telephone Number:
787-644-6120

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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