1386744431 NPI number — CONSULTORIO CLINICO MEDICOS A SU ORDEN

Table of content: (NPI 1386744431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386744431 NPI number — CONSULTORIO CLINICO MEDICOS A SU ORDEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTORIO CLINICO MEDICOS A SU ORDEN
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:
1386744431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANOVANAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00729-0042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-242-0072
Provider Business Mailing Address Fax Number:
787-727-4794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 CALLE SANTA CECILIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00911-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-242-0072
Provider Business Practice Location Address Fax Number:
787-727-4794
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESPINAL-U
Authorized Official First Name:
MAXIMILIEN
Authorized Official Middle Name:
RODOLFO
Authorized Official Title or Position:
PRINCIPAL OFFICE
Authorized Official Telephone Number:
787-242-0072

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X , with the licence number:  15414 , 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)





Copyright © 2007-2024 www.npivalidator.com