1043420359 NPI number — ASOCIACION DE MEDICOS GENERALISTAS DE COROZAL

Table of content: (NPI 1043420359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043420359 NPI number — ASOCIACION DE MEDICOS GENERALISTAS DE COROZAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASOCIACION DE MEDICOS GENERALISTAS DE COROZAL
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:
1043420359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94000 PMB 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COROZAL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-859-5434
Provider Business Mailing Address Fax Number:
787-859-6452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE LAS MERCEDES #23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-5434
Provider Business Practice Location Address Fax Number:
787-859-6452
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORITZ CALDERO
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRADOR
Authorized Official Telephone Number:
787-859-6452

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  6333 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X , with the licence number: 6237 , 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)





Copyright © 2007-2025 www.npivalidator.com