1033777180 NPI number — PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC

Table of content: (NPI 1033777180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033777180 NPI number — PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
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:
1033777180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 195615
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:
00919-5615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-523-5767
Provider Business Mailing Address Fax Number:
800-920-7754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 AVE LAS CUMBRES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-5523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-789-2101
Provider Business Practice Location Address Fax Number:
800-920-7754
Provider Enumeration Date:
06/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DELGADO
Authorized Official First Name:
NARDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
787-523-5767

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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