1861663916 NPI number — SISTEMAS MEDICOS NACIONOLES SA DE CV

Table of content: (NPI 1861663916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861663916 NPI number — SISTEMAS MEDICOS NACIONOLES SA DE CV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTEMAS MEDICOS NACIONOLES SA DE CV
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:
SIMNSA HEALTH PLAN
Provider Other Organization Name Type Code:
3
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:
1861663916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2088 OTAY LAKES ROAD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-424-4652
Provider Business Mailing Address Fax Number:
619-407-4087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AV. PASEO TIJUANA # 406-102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIJUANA
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
22320
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
800-424-4652
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SUGGETT
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
619-407-4082

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  933393 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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