1134598337 NPI number — OFICINA MEDICA PRIMARIA DEL SUR 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 1134598337 NPI number — OFICINA MEDICA PRIMARIA DEL SUR CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OFICINA MEDICA PRIMARIA DEL SUR 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:
1134598337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 446
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUANICA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00653-0446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-992-7199
Provider Business Mailing Address Fax Number:
787-992-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 INFANTERIA A1
Provider Second Line Business Practice Location Address:
LOCAL ANEXO REMA
Provider Business Practice Location Address City Name:
YAUCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-992-7199
Provider Business Practice Location Address Fax Number:
787-992-7199
Provider Enumeration Date:
09/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ MORENO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-690-2644

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  16881 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 15915 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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