1205618048 NPI number — INTER AMERICAN UNIVERSITY OF PUERTO RICO

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 1205618048 NPI number — INTER AMERICAN UNIVERSITY OF PUERTO RICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTER AMERICAN UNIVERSITY OF PUERTO RICO
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:
1205618048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CARR DR. JOHN WILL HARRIS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00957-6257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-765-1915
Provider Business Mailing Address Fax Number:
787-765-9854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. EL JIBARO CARR. 172 KM 135
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIDRA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-739-8182
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PAGAN
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
Authorized Official Title or Position:
DEAN
Authorized Official Telephone Number:
787-765-1915

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037652204 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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