1104543487 NPI number — GUOMET-AV INC

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 1104543487 NPI number — GUOMET-AV INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUOMET-AV 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:
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:
1104543487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CORREO VILLA AA-2
Provider Second Line Business Mailing Address:
AVE. TEJAS PMB 216
Provider Business Mailing Address City Name:
HUMACO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-852-2470
Provider Business Mailing Address Fax Number:
787-285-4165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 CALLE JESUS T PINERO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-2470
Provider Business Practice Location Address Fax Number:
787-285-4165
Provider Enumeration Date:
10/26/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALGARIN
Authorized Official First Name:
ELBA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENTA
Authorized Official Telephone Number:
787-852-2470

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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