1114190436 NPI number — NAVARRO HEALTH CENTER PSC

Table of content: (NPI 1114190436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114190436 NPI number — NAVARRO HEALTH CENTER PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVARRO HEALTH CENTER PSC
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:
1114190436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 3 S 5 VILLA MARIA
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:
00725-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-747-2081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PARCELA 229 BO. NAVARRO CALLE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-747-2081
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVILA MORALES
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-462-8248

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  15988 , 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)