1134368822 NPI number — WESTERN NEONATAL 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 1134368822 NPI number — WESTERN NEONATAL SERVICES, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN NEONATAL 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:
1134368822
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIF MEDICO IV # OFIC203
Provider Second Line Business Mailing Address:
CALLE DR BASORA 55N
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-8280
Provider Business Mailing Address Fax Number:
787-834-8280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF MEDICO IV # OFIC203
Provider Second Line Business Practice Location Address:
CALLE DR BASORA 55N
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-8280
Provider Business Practice Location Address Fax Number:
787-834-8280
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ OLMO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-834-8280

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  9338 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 5774 , 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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