1235229931 NPI number — AYALA ORTA MEDICAL SERVICE PSC

Table of content: (NPI 1235229931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235229931 NPI number — AYALA ORTA MEDICAL SERVICE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AYALA ORTA MEDICAL SERVICE PSC
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:
1235229931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6431
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-827-2433
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 AVE MATIAS BRUGMAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS MARIAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00670-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-827-2433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDONA
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
ORTA
Authorized Official Title or Position:
PROPIETARIA
Authorized Official Telephone Number:
787-827-2433

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10028W . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2909 . This is a "PMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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