1396148094 NPI number — DR DOMENECH FIGUEROA RIVERA MD CSP

Table of content: (NPI 1396148094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396148094 NPI number — DR DOMENECH FIGUEROA RIVERA MD CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR DOMENECH FIGUEROA RIVERA MD CSP
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:
1396148094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142601
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-816-1212
Provider Business Mailing Address Fax Number:
787-881-6392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. # 2 KM. 67.3
Provider Second Line Business Practice Location Address:
BO. SANTANA
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-816-1212
Provider Business Practice Location Address Fax Number:
787-881-6392
Provider Enumeration Date:
10/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA RIVERA
Authorized Official First Name:
DOMENECH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-816-1212

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  14906 , 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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