1922414812 NPI number — CENTRO DE MEDICINA PREVENTIVA CERV,CSP

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 1922414812 NPI number — CENTRO DE MEDICINA PREVENTIVA CERV,CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE MEDICINA PREVENTIVA CERV,CSP
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:
1922414812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROCOVIS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00720-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-8085
Provider Business Mailing Address Fax Number:
939-212-7459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 CALLE LUIS M ALFARO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROCOVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00720-4467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-867-8085
Provider Business Practice Location Address Fax Number:
939-212-7459
Provider Enumeration Date:
07/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CARLOS
Authorized Official First Name:
RODRIGUEZ
Authorized Official Middle Name:
EULOGIO
Authorized Official Title or Position:
MEDICO
Authorized Official Telephone Number:
787-867-8085

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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