1285058198 NPI number — BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO

Table of content: (NPI 1285058198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285058198 NPI number — BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO
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:
6
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:
1285058198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-273-0597
Provider Business Mailing Address Fax Number:
407-499-4655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
V3-22 AVE SAN ALFONSO
Provider Second Line Business Practice Location Address:
URB. LAS LOMAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-273-0597
Provider Business Practice Location Address Fax Number:
407-499-4655
Provider Enumeration Date:
02/12/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
MIRIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-273-0597

Provider Taxonomy Codes

  • Taxonomy code: 332G00000X , with the licence number:  7349 , 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)

  • Identifier: 7349 . This is a "INCORPORATED REGISTER #7349" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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