1083758163 NPI number — CENTRO MEDICO DEL TURABO INC

Table of content: (NPI 1083758163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083758163 NPI number — CENTRO MEDICO DEL TURABO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO DEL TURABO 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:
1083758163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-3434
Provider Business Mailing Address Fax Number:
787-961-1901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIMA SAN PABLO FAJARDO
Provider Second Line Business Practice Location Address:
AVE GENERAL VALERO 404
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-655-0505
Provider Business Practice Location Address Fax Number:
787-655-5086
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ORLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-653-3434

Provider Taxonomy Codes

  • Taxonomy code: 207PP0204X , with the licence number:  6893 , 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: 11744 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6893 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7291 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 14540 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 10792 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 12373 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 12929 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 10483 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4494 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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