1114186285 NPI number — ALEJANDRO BAUZA CORDERO SR. CONSEJERO PROFECIONA

Table of content: ALEJANDRO BAUZA CORDERO SR. CONSEJERO PROFECIONA (NPI 1114186285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114186285 NPI number — ALEJANDRO BAUZA CORDERO SR. CONSEJERO PROFECIONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUZA CORDERO
Provider First Name:
ALEJANDRO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
SR.
Provider Credential Text:
CONSEJERO PROFECIONA
Provider Gender Code:
M

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:
1114186285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-785-6690
Provider Business Mailing Address Fax Number:
787-780-3103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MAGA FRENTE AL HOSPITAL DE PSICIATRIA
Provider Second Line Business Practice Location Address:
CENTROMEDICO DRUG COURT ASSMCA
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-641-0774
Provider Business Practice Location Address Fax Number:
787-641-2759
Provider Enumeration Date:
06/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  2162 , 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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