1295768232 NPI number — CENTRO MEDICO DEL TURABO INC.

Table of content: (NPI 1295768232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295768232 NPI number — CENTRO MEDICO DEL TURABO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MEDICO DEL TURABO INC.
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:
1295768232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-653-3434
Provider Business Mailing Address Fax Number:
787-653-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LUIS MUNOZ MARIN AVE
Provider Second Line Business Practice Location Address:
URB.MARIOLGA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-3434
Provider Business Practice Location Address Fax Number:
787-653-1799
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JOAQUIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN, CEO
Authorized Official Telephone Number:
787-653-3434

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  13 , 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: 97-214 . This is a "CNC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83587 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 13 . This is a "STATE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 012883600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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