1336228311 NPI number — RECETAS PRO MENOS INC

Table of content: (NPI 1336228311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336228311 NPI number — RECETAS PRO MENOS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECETAS PRO MENOS 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:
1336228311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 CALLE SANTA ANA
Provider Second Line Business Mailing Address:
ESQUINA FIDALGO DIAZ
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00909-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-722-8914
Provider Business Mailing Address Fax Number:
787-752-3660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#5 BB-9 PARQUE HERMOSO
Provider Second Line Business Practice Location Address:
VILLA FONTANA PARK
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-752-3335
Provider Business Practice Location Address Fax Number:
787-752-3360
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-722-8914

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  19F2168 , 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: 2082888 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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