1790997617 NPI number — PABLO ROSARIO ORTIZ

Table of content: (NPI 1790997617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790997617 NPI number — PABLO ROSARIO ORTIZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PABLO ROSARIO ORTIZ
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:
1790997617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-734-0474
Provider Business Mailing Address Fax Number:
787-734-0777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 929 KM 1
Provider Second Line Business Practice Location Address:
BO LIRIOS
Provider Business Practice Location Address City Name:
JUNCOS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-734-0474
Provider Business Practice Location Address Fax Number:
787-734-0777
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSARIO
Authorized Official First Name:
PABLO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRADOR
Authorized Official Telephone Number:
787-734-0474

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TCAMB163 , 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: 6107 . This is a "AMERICAN HEALTH MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8100028 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9003134 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PMC . This is a "990295" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890272 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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