1144666231 NPI number — CENTER FOR ENDOCRINE & LAPAROSCOPIC SURGERY

Table of content: EDWARD PAUL DESVERNINE DC (NPI 1437280104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144666231 NPI number — CENTER FOR ENDOCRINE & LAPAROSCOPIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ENDOCRINE & LAPAROSCOPIC SURGERY
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:
1144666231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 CALLE SAN JORGE STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00911-2176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-723-4525
Provider Business Mailing Address Fax Number:
787-721-2574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. FERNANDEZ JUNCOS 1427 SUITE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00910-2174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-433-3323
Provider Business Practice Location Address Fax Number:
787-721-2574
Provider Enumeration Date:
05/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-723-4525

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  12368 , 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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