1154629996 NPI number — CONSULTORIO MEDICO DR. OBED R. GARCIA ACEVEDO, CSP

Table of content: (NPI 1154629996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154629996 NPI number — CONSULTORIO MEDICO DR. OBED R. GARCIA ACEVEDO, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTORIO MEDICO DR. OBED R. GARCIA ACEVEDO, 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:
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Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154629996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69001
Provider Second Line Business Mailing Address:
PMB 195
Provider Business Mailing Address City Name:
HATILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00659-6901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-898-6511
Provider Business Mailing Address Fax Number:
787-544-6040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 129 KM 8.3
Provider Second Line Business Practice Location Address:
BO CAMPO ALEGRE
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-898-6511
Provider Business Practice Location Address Fax Number:
787-544-6040
Provider Enumeration Date:
03/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA ACEVEDO
Authorized Official First Name:
OBED
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-597-1167

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  151665 , 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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