1942432695 NPI number — GRUPO DE SERVICIOS MEDICOS CDV

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 1942432695 NPI number — GRUPO DE SERVICIOS MEDICOS CDV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO DE SERVICIOS MEDICOS CDV
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:
1942432695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364942
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-4942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-972-1233
Provider Business Mailing Address Fax Number:
787-946-3799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 CARR 592
Provider Second Line Business Practice Location Address:
BO. AMUELAS
Provider Business Practice Location Address City Name:
JUANA DIAZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00795-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-972-1233
Provider Business Practice Location Address Fax Number:
787-946-3799
Provider Enumeration Date:
08/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ-SCHMIDT
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-972-1333

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , 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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