1023061694 NPI number — CLINICA OFTALMICA QUADRANGLE PSC

Table of content: PHUONGTAM NGOC NGUYEN PHARM.D. (NPI 1982980967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023061694 NPI number — CLINICA OFTALMICA QUADRANGLE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA OFTALMICA QUADRANGLE 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:
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:
1023061694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-0340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-746-6460
Provider Business Mailing Address Fax Number:
787-746-6467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 AVE LUIS MUNOZ MARIN
Provider Second Line Business Practice Location Address:
QUADRANGLE MEDICAL CENTER SUITE 203
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-3975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-746-6460
Provider Business Practice Location Address Fax Number:
787-746-6467
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-746-6460

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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