1760455109 NPI number — ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO

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 1760455109 NPI number — ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADMINISTRACION DE SERVICIOS MEDICOS DE PUERTO RICO
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:
1760455109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00922-2129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-777-3535
Provider Business Mailing Address Fax Number:
787-777-3481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO MONACILLOS
Provider Second Line Business Practice Location Address:
CARR NO 22 RIO PIEDRAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00922-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-3535
Provider Business Practice Location Address Fax Number:
787-777-3481
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMENDARIS
Authorized Official First Name:
ANA
Authorized Official Middle Name:
RIUS
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-777-3483

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , 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: 018403400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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