1740542695 NPI number — CLINICA ESPECIALIZADA DR. ANGEL E. RIVERA NEGRON, INC.

Table of content: (NPI 1740542695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740542695 NPI number — CLINICA ESPECIALIZADA DR. ANGEL E. RIVERA NEGRON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA ESPECIALIZADA DR. ANGEL E. RIVERA NEGRON, INC.
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:
1740542695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1745
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARCELONETA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00617-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-846-5094
Provider Business Mailing Address Fax Number:
787-846-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 140 KM. 68.1 BO. PUEBLO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARCELONETA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-846-5094
Provider Business Practice Location Address Fax Number:
787-846-5962
Provider Enumeration Date:
06/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-846-5094

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  13933 , 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)

  • Identifier: 1902825334 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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