1205855228 NPI number — POLICLINICAS DE PONCE

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 1205855228 NPI number — POLICLINICAS DE PONCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLICLINICAS DE PONCE
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:
1205855228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 261 PO BOX 7105
Provider Second Line Business Mailing Address:
MORREL CAMPOS
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-7105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-812-3153
Provider Business Mailing Address Fax Number:
787-290-6689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZOLETA PONCE CASH & CARRY LOCAL 4 MORELL CAMPOS
Provider Second Line Business Practice Location Address:
MORREL CAMPOS
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00732-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-3153
Provider Business Practice Location Address Fax Number:
787-290-6689
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ DROZ
Authorized Official First Name:
EFRAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRADOR MEDICO
Authorized Official Telephone Number:
787-812-3193

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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