1679891071 NPI number — KBAUCAGE FISIATRA

Table of content: MIRTHA MARELIS CASTANEDA ALVAREZ (NPI 1710713409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679891071 NPI number — KBAUCAGE FISIATRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KBAUCAGE FISIATRA
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:
1679891071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-819-5900
Provider Business Mailing Address Fax Number:
787-882-5405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SEVERIANO CUEVAS # 18
Provider Second Line Business Practice Location Address:
HOSPITAL BUEN SAMARITANO
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-891-4833
Provider Business Practice Location Address Fax Number:
787-882-5405
Provider Enumeration Date:
05/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAUCAGE
Authorized Official First Name:
KATHIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-819-5900

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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