1992486039 NPI number — MER NEPHROLOGY AND HYPERTENSION CLINIC LLC

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 1992486039 NPI number — MER NEPHROLOGY AND HYPERTENSION CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MER NEPHROLOGY AND HYPERTENSION CLINIC LLC
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:
1992486039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11577, FERNANDEZ JUNCOS STATION
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-723-5017
Provider Business Mailing Address Fax Number:
787-723-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1492 AVE PONCE DE LEON STE 502
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-723-5017
Provider Business Practice Location Address Fax Number:
787-723-5015
Provider Enumeration Date:
07/31/2023

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA HERNANDEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
NEPHROLOGIST
Authorized Official Telephone Number:
787-723-5017

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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