1740326677 NPI number — GRUPO OTORRINOLARINGOLOGICO DE PR

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 1740326677 NPI number — GRUPO OTORRINOLARINGOLOGICO DE PR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO OTORRINOLARINGOLOGICO DE PR
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:
1740326677
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:
BAYAMON MEDICAL PLAZA
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-8981
Provider Business Mailing Address Fax Number:
787-780-4866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA CAROLINA MALL
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-776-1511
Provider Business Practice Location Address Fax Number:
787-776-1531
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ MENDIOLA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-785-8981

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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