1760628366 NPI number — CENTRO MEDICO FAMILIAR Y MEDICINA INTEGRAL Y COMPLEMENTARIA DE RIO PIE

Table of content: DR. ATHANASIOS THOMAS DALAGIANNIS M.D. (NPI 1871565267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760628366 NPI number — CENTRO MEDICO FAMILIAR Y MEDICINA INTEGRAL Y COMPLEMENTARIA DE RIO PIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO FAMILIAR Y MEDICINA INTEGRAL Y COMPLEMENTARIA DE RIO PIE
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:
1760628366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29764
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:
00929-0764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-754-7133
Provider Business Mailing Address Fax Number:
787-771-9131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 CALLE ARIZMENDI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00925-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-754-7133
Provider Business Practice Location Address Fax Number:
787-771-9131
Provider Enumeration Date:
01/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA MOLINA
Authorized Official First Name:
ZORAIDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-754-7133

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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