1336570043 NPI number — ATLANTIS HEALTH CARE GROUP PUERTO RICO, INC.

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 1336570043 NPI number — ATLANTIS HEALTH CARE GROUP PUERTO RICO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIS HEALTH CARE GROUP PUERTO RICO, 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:
1336570043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1350
Provider Second Line Business Mailing Address:
ST. JUST STATION
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00977-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-7979
Provider Business Mailing Address Fax Number:
787-292-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE JOSE EFRON
Provider Second Line Business Practice Location Address:
ESQUINA 696
Provider Business Practice Location Address City Name:
DORADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00646-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-292-7979
Provider Business Practice Location Address Fax Number:
787-292-7999
Provider Enumeration Date:
12/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HARFORD
Authorized Official First Name:
RUBETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
787-292-7979

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  #44 , 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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