1831478130 NPI number — GRUPO MEDICO DE CAMUY, INC.

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 1831478130 NPI number — GRUPO MEDICO DE CAMUY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICO DE CAMUY, INC.
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:
1831478130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9975
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-9975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-898-7990
Provider Business Mailing Address Fax Number:
787-898-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 129
Provider Second Line Business Practice Location Address:
BARRIO BAYANEY KM 15.1
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-898-7990
Provider Business Practice Location Address Fax Number:
787-898-7990
Provider Enumeration Date:
08/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA NATAL
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-406-0172

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  5972 , 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)





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