1699016295 NPI number — LMA COSMETIC, ORAL AND MAXILLOFACIAL SURGERY SERVICES, PSC

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 1699016295 NPI number — LMA COSMETIC, ORAL AND MAXILLOFACIAL SURGERY SERVICES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LMA COSMETIC, ORAL AND MAXILLOFACIAL SURGERY SERVICES, PSC
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:
1699016295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAS CATALINAS MALL
Provider Second Line Business Mailing Address:
CARIBBEAN CINEMAS SUITE 205
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-961-8090
Provider Business Mailing Address Fax Number:
787-961-8099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAS CATALINAS MALL
Provider Second Line Business Practice Location Address:
CARIBBEAN CINEMAS SUITE 205
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-961-8090
Provider Business Practice Location Address Fax Number:
787-961-8099
Provider Enumeration Date:
03/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
AROCHO
Authorized Official First Name:
LIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-346-3844

Provider Taxonomy Codes

  • Taxonomy code: 261QS0112X , with the licence number:  2673 , 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)





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