1821021213 NPI number — EQUIPO GINECOLOGICO Y OBSTETRICO DE SALUD,P.S.C.

Table of content: (NPI 1821021213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821021213 NPI number — EQUIPO GINECOLOGICO Y OBSTETRICO DE SALUD,P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EQUIPO GINECOLOGICO Y OBSTETRICO DE SALUD,P.S.C.
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:
E.G.O.S., P.S.C.
Provider Other Organization Name Type Code:
4
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:
1821021213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 CALLE FONT MARTELO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMACAO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791-3337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-852-3560
Provider Business Mailing Address Fax Number:
787-852-3538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 AVE DEGETAU APT 500
Provider Second Line Business Practice Location Address:
HIMA PLAZA I SUITE 505
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-5844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-5414
Provider Business Practice Location Address Fax Number:
787-258-4587
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAVAS MICHEO
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-744-5414

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67906 . This is a "LA CRUZ AZUL DE PUERTO RI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 89732 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE1198 . This is a "PAN AMERICAN LIFE INS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2501 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6610095 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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