1982681565 NPI number — SERVICIOS INTEGRADOS DE REHABILITACION DEL OESTE INC.

Table of content: HEIDI LUKINAC MA LPCC (NPI 1417796111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982681565 NPI number — SERVICIOS INTEGRADOS DE REHABILITACION DEL OESTE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS INTEGRADOS DE REHABILITACION DEL OESTE 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:
1982681565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORMIGUEROS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00660-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-849-2179
Provider Business Mailing Address Fax Number:
787-849-2205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET 4 HOUSE L-10
Provider Second Line Business Practice Location Address:
COLINAS DEL OESTE
Provider Business Practice Location Address City Name:
HORMIGUEROS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-849-2179
Provider Business Practice Location Address Fax Number:
787-849-2205
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
DAISY
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE DIRECTOR
Authorized Official Telephone Number:
787-849-2179

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  6 , 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: 33-03837 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7285934 . This is a "CIGNA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 223153 . This is a "PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3228-5 . This is a "AMPR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 00432 . This is a "AMERICAN HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6600020 . This is a "HUMANA AMB" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7951 . This is a "IMC/AMB" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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