1023306404 NPI number — WHITE CLIFF CORPORATION

Table of content: (NPI 1023306404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023306404 NPI number — WHITE CLIFF CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE CLIFF CORPORATION
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:
1023306404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8477
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:
787-399-0611
Provider Business Mailing Address Fax Number:
787-721-3444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE PONCE DE LEON # 1519
Provider Second Line Business Practice Location Address:
SUITE 809
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-399-0611
Provider Business Practice Location Address Fax Number:
787-721-3444
Provider Enumeration Date:
07/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AGRELO
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-399-0611

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 199155 . This is a "COPORATION NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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