1124256698 NPI number — CDT TRUJILLO ALTO

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 1124256698 NPI number — CDT TRUJILLO ALTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDT TRUJILLO ALTO
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:
1124256698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1869
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00977-1869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-908-3107
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LAGO ALTO
Provider Second Line Business Practice Location Address:
CALLE CARITE 130
Provider Business Practice Location Address City Name:
TRUJILLO ALTO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-908-3107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HUMBERTO
Authorized Official First Name:
MONSERRATE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-908-3107

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , 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)





Copyright © 2007-2026 www.npivalidator.com