1750316006 NPI number — CENTRO MEDICO DEL TURABO INC.

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 1750316006 NPI number — CENTRO MEDICO DEL TURABO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO DEL TURABO 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:
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:
1750316006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-3434
Provider Business Mailing Address Fax Number:
787-653-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 AVE GENERAL VALERO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-655-0505
Provider Business Practice Location Address Fax Number:
787-655-5052
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JOAQUIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN,CEO
Authorized Official Telephone Number:
787-653-3434

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  CNC 05-091 , 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: 0081026 . This is a "ANESTHESIA MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CNC 05-091 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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