1992000855 NPI number — IDXPERT, P.C.

Table of content: (NPI 1992000855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992000855 NPI number — IDXPERT, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDXPERT, P.C.
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:
1992000855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SABANA SECA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00952-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-3434
Provider Business Mailing Address Fax Number:
314-222-0614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIMA-SAN PABLO CAGUAS HOSPITAL
Provider Second Line Business Practice Location Address:
100 LUIS MUNOZ MARIN AVE., URB. MARIOLGA
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:
314-222-0614
Provider Enumeration Date:
01/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-653-3434

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  17784 , 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: EM624A . This is a "MEDICARE PTAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8757559 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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