1972051365 NPI number — MMT NEUROSURGERY PSC

Table of content: (NPI 1972051365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972051365 NPI number — MMT NEUROSURGERY PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMT NEUROSURGERY PSC
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:
1972051365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
E17 CALLE 1
Provider Second Line Business Mailing Address:
PASEO MAYOR
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-963-0039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIMA HOSPITAL
Provider Second Line Business Practice Location Address:
TORRE HIMA SUITE 706
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-3434
Provider Business Practice Location Address Fax Number:
787-653-3527
Provider Enumeration Date:
09/14/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOGALES
Authorized Official First Name:
GUSTAVO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-378-6773

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  14011 , 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)