1104290410 NPI number — CER MEDICAL SERVICES CSP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104290410 NPI number — CER MEDICAL SERVICES CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CER MEDICAL SERVICES CSP
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:
1104290410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9115
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:
00726-9115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-8802
Provider Business Mailing Address Fax Number:
787-961-9649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2E 1 ESQ BONAPARTE
Provider Second Line Business Practice Location Address:
URB VILLA DEL REY 2NDA SEC
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-8802
Provider Business Practice Location Address Fax Number:
787-961-9649
Provider Enumeration Date:
11/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-653-8802

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  13830 , 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)





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