1053508267 NPI number — TALLER INTEGRAL CORP.

Table of content: (NPI 1053508267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053508267 NPI number — TALLER INTEGRAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALLER INTEGRAL CORP.
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:
1053508267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 46
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-0046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-884-0087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 10 BLOQUE 3 #32
Provider Second Line Business Practice Location Address:
URBANIZACION VILLA NITZA
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-0046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-0087
Provider Business Practice Location Address Fax Number:
787-884-0087
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DE JESUS GARCIA
Authorized Official First Name:
MARIA DE LOS
Authorized Official Middle Name:
ANGELES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-884-0087

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1136 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 1136 , 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)

  • Identifier: 1659443026 . This is a "INDIVIDUL NPI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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