1023588514 NPI number — ENDOCRINOLOGY AND DIABETES WELLNESS CENTER

Table of content: (NPI 1023588514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023588514 NPI number — ENDOCRINOLOGY AND DIABETES WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDOCRINOLOGY AND DIABETES WELLNESS CENTER
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:
1023588514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 AVE CARLOS CHARDON COND QUANTUM METROCENTER
Provider Second Line Business Mailing Address:
APT 150
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-447-5200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB ATENAS HERNANDEZ CARRION OFICINA 213
Provider Second Line Business Practice Location Address:
MANATI MEDICAL CENTER PROFESSIONAL PLAZA
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-621-4828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO GUTIERREZ
Authorized Official First Name:
NAOMI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-447-5200

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com