1023606910 NPI number — COSTA SALUD COMMUNITY HEALTH CENTERS INC

Table of content: (NPI 1023606910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023606910 NPI number — COSTA SALUD COMMUNITY HEALTH CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COSTA SALUD COMMUNITY HEALTH CENTERS INC
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:
6
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:
1023606910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RINCON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00677-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-252-5500
Provider Business Mailing Address Fax Number:
787-252-5504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO ASOMANTE
Provider Second Line Business Practice Location Address:
106 CALLE COLON
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-252-5500
Provider Business Practice Location Address Fax Number:
787-252-5504
Provider Enumeration Date:
01/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
SUSANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-823-5500

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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