1194169185 NPI number — MAYAGUEZ AMBULATORY SURGICAL CENTER

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 1194169185 NPI number — MAYAGUEZ AMBULATORY SURGICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYAGUEZ AMBULATORY SURGICAL CENTER
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:
1194169185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CITY VIEW PLAZA 1010
Provider Second Line Business Mailing Address:
STREET 165 KM 1.2 # 48
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-522-2825
Provider Business Mailing Address Fax Number:
787-522-2848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAYAGUEZ TOWN CENTER
Provider Second Line Business Practice Location Address:
POST STREET # 252 LOCAL 1
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-522-2825
Provider Business Practice Location Address Fax Number:
787-522-2848
Provider Enumeration Date:
04/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
JIMENEZ
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-522-2825

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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