1306080155 NPI number — SERVICIOS MEDICOS GERIATRICOS EN EL HOGAR

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 1306080155 NPI number — SERVICIOS MEDICOS GERIATRICOS EN EL HOGAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS MEDICOS GERIATRICOS EN EL HOGAR
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:
1306080155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00733-6149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-813-0080
Provider Business Mailing Address Fax Number:
787-840-8874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA MARIA SHOPP CTR
Provider Second Line Business Practice Location Address:
2DO PISO OFICINA 225
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-4199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-813-0080
Provider Business Practice Location Address Fax Number:
787-840-8874
Provider Enumeration Date:
04/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
IVETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTORA DE OPERACIONES FISCALES
Authorized Official Telephone Number:
787-813-0080

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  8902 , 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)





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