1972531218 NPI number — DR SUSONI HEALTH COMMUNITY SERVICES CORP

Table of content: (NPI 1972531218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972531218 NPI number — DR SUSONI HEALTH COMMUNITY SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SUSONI HEALTH COMMUNITY SERVICES CORP
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:
HOSPITAL PAVIA ARECIBO
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:
1972531218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 659
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-0659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-650-7272
Provider Business Mailing Address Fax Number:
787-650-7310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE SAN LUIS
Provider Second Line Business Practice Location Address:
CARR 129 KM 0.1
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-650-7272
Provider Business Practice Location Address Fax Number:
787-650-7310
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
787-650-7272

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2CNC00143 , 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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