1194170175 NPI number — INSTITUTO FISIATRICO DE AIBONITO CSP

Table of content: (NPI 1194170175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194170175 NPI number — INSTITUTO FISIATRICO DE AIBONITO CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTO FISIATRICO DE AIBONITO 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:
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:
1194170175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 197
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00786-0197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-735-2445
Provider Business Mailing Address Fax Number:
787-991-0885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CALLE JOSE C VAZQUEZ
Provider Second Line Business Practice Location Address:
FRENTE HOSPITAL MENONITA
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-2445
Provider Business Practice Location Address Fax Number:
787-991-0885
Provider Enumeration Date:
04/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LUGO
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-486-7168

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X , with the licence number:  12266 , 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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