1962472845 NPI number — CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO 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 1962472845 NPI number — CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO 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:
1962472845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MEDICAL OPHTHALMIC PLAZA
Provider Second Line Business Mailing Address:
1875 CARR 2 SUITE 303
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959-7217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-780-0404
Provider Business Mailing Address Fax Number:
787-780-0411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL OPHTHALMIC PLAZA
Provider Second Line Business Practice Location Address:
1875 CARR 2 SUITE 303
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-0404
Provider Business Practice Location Address Fax Number:
787-780-0411
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOLLINCHE
Authorized Official First Name:
MARCEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-780-0404

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  3 CNC 97 206 , 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)

  • Identifier: 3CNC97206 . This is a "AMBULATORY SURGERY CENTER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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