1730566894 NPI number — CEDENO LACLAUSTRA MD PSC

Table of content: (NPI 1730566894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730566894 NPI number — CEDENO LACLAUSTRA MD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDENO LACLAUSTRA MD 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:
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:
1730566894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 5103-216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-237-1613
Provider Business Mailing Address Fax Number:
787-652-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 311 KM 6.2
Provider Second Line Business Practice Location Address:
B.O CERILLOS URB LAS VISTOS
Provider Business Practice Location Address City Name:
CABO ROJO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-237-1613
Provider Business Practice Location Address Fax Number:
787-652-1661
Provider Enumeration Date:
04/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
ZAPATA
Authorized Official Title or Position:
ENCAGADO CREDENCIALES Y DOCUMENTOS
Authorized Official Telephone Number:
787-372-5251

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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