1023360070 NPI number — JEZREELCITAS

Table of content: (NPI 1023360070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023360070 NPI number — JEZREELCITAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEZREELCITAS
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:
1023360070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 987
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN LORENZO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00754-0987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-370-5021
Provider Business Mailing Address Fax Number:
787-715-2221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. FLORIDA CARRETERA 183 RAMAL 9929
Provider Second Line Business Practice Location Address:
KM 1.6
Provider Business Practice Location Address City Name:
SAN LORENZO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00754-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-370-5021
Provider Business Practice Location Address Fax Number:
787-715-2221
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
OSVALDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PESIDENT
Authorized Official Telephone Number:
787-370-5021

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , with the licence number:  PCVTE 4440 , 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)





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