1326086232 NPI number — CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P

Table of content: (NPI 1326086232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326086232 NPI number — CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE MANEJO DEL DOLOR DR CRAWFORD W LONG C S P
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:
1326086232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1869
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIBONITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00705-1869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-735-8900
Provider Business Mailing Address Fax Number:
787-735-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 CALLE JULIO CINTRON
Provider Second Line Business Practice Location Address:
EDIFICIO GUAYACAN SUITE 224
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-8900
Provider Business Practice Location Address Fax Number:
787-735-3040
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
IBARRA
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-735-8900

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  7701 , 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: 0082070 . This is a "PETAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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