1023547643 NPI number — ARIST MEDICAL SCIENCES UNIVERSITY, PBC

Table of content: (NPI 1023547643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023547643 NPI number — ARIST MEDICAL SCIENCES UNIVERSITY, PBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIST MEDICAL SCIENCES UNIVERSITY, PBC
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:
PHSU WELLNESS CENTER
Provider Other Organization Name Type Code:
3
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:
1023547643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-7004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-840-0052
Provider Business Mailing Address Fax Number:
787-840-2317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
396 CALLE DR LUIS F SALA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-0052
Provider Business Practice Location Address Fax Number:
787-840-2317
Provider Enumeration Date:
06/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CASTAING LESPIER
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DEAN FOR CLINICAL OPERATIONS
Authorized Official Telephone Number:
787-840-0052

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IF404A , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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