1336932334 NPI number — PROMOTORA MEDICA Y ODONTOLOGICA DE ANTIOQUIA S.A.

Table of content: (NPI 1336932334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336932334 NPI number — PROMOTORA MEDICA Y ODONTOLOGICA DE ANTIOQUIA S.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMOTORA MEDICA Y ODONTOLOGICA DE ANTIOQUIA S.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1336932334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11597
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33339-1597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 53 46 38 PISO 1, LA CANDELARIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDELLIN
Provider Business Practice Location Address State Name:
ANTIOQUIA
Provider Business Practice Location Address Postal Code:
99999
Provider Business Practice Location Address Country Code:
CO
Provider Business Practice Location Address Telephone Number:
604-322-1125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2025

Additional Information

Authorized Official

Authorized Official Last Name:
SANTIAGO
Authorized Official First Name:
WILFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
604-322-1125

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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