1811952195 NPI number — DR. JOSE LUIS COLLADO MARCIAL SR. M.D., M.P.H.

Table of content: DR. JOSE LUIS COLLADO MARCIAL SR. M.D., M.P.H. (NPI 1811952195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811952195 NPI number — DR. JOSE LUIS COLLADO MARCIAL SR. M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLADO MARCIAL
Provider First Name:
JOSE
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
M

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:
1811952195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9506 VIA PELICANOS
Provider Second Line Business Mailing Address:
CAMINO DEL MAR
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-4385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-510-0864
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MOROVIS COMMUNITY HEALTH CENTER INC
Provider Second Line Business Practice Location Address:
2 CALLE PATRON
Provider Business Practice Location Address City Name:
MOROVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00687-0068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-862-3000
Provider Business Practice Location Address Fax Number:
787-862-2731
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  7305 , 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)