1205046786 NPI number — PEREZ- BETANCOURT MEDICAL, P.S.C

Table of content: (NPI 1205046786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205046786 NPI number — PEREZ- BETANCOURT MEDICAL, P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEREZ- BETANCOURT MEDICAL, P.S.C
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:
1205046786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 381 220 WESTERN AUTO PLAZA
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-2305
Provider Business Mailing Address Fax Number:
787-761-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 848 KM 0.0
Provider Second Line Business Practice Location Address:
CENTRO -4 PLAZA SUITE 202
Provider Business Practice Location Address City Name:
TRUJILLO ALTO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-2305
Provider Business Practice Location Address Fax Number:
787-761-1895
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ-CHIESA
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-761-2305

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  7963 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 5693 , 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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