1003003484 NPI number — POLICLINICA SAN PEDRO PSC

Table of content: (NPI 1003003484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003003484 NPI number — POLICLINICA SAN PEDRO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLICLINICA SAN PEDRO 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:
6
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:
1003003484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARROYO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00714-0818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-839-3980
Provider Business Mailing Address Fax Number:
787-839-2515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 CALLE MORSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARROYO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00714-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-839-3980
Provider Business Practice Location Address Fax Number:
787-839-2515
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA IRIZARRY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-839-3980

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  229 , 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: 37394 . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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