1215208012 NPI number — CENTRO MEDICO DE ESPECIALIDADES SAMANA

Table of content: LUIS DIEGO RAZZETO RUBIO M.D. (NPI 1982229738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215208012 NPI number — CENTRO MEDICO DE ESPECIALIDADES SAMANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO DE ESPECIALIDADES SAMANA
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:
1215208012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C/O 220 EAST MONUMENT AVE. SUITE B SUITE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-931-1717
Provider Business Mailing Address Fax Number:
407-931-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE CORONEL ANDRES DIAZ NO. 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAMANA
Provider Business Practice Location Address State Name:
SAMANA
Provider Business Practice Location Address Postal Code:
NONE
Provider Business Practice Location Address Country Code:
DO
Provider Business Practice Location Address Telephone Number:
809-538-3888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MENA
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
809-538-3888

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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