1407989890 NPI number — ECO-CARDIOVASCULAR TESTING LAB

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 1407989890 NPI number — ECO-CARDIOVASCULAR TESTING LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECO-CARDIOVASCULAR TESTING LAB
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:
1407989890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9065054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00906-5054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-3463
Provider Business Mailing Address Fax Number:
787-798-3463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
E12 CALLE 2
Provider Second Line Business Practice Location Address:
URBANIZACION SANTA CRUZ
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-3463
Provider Business Practice Location Address Fax Number:
787-798-3463
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLAZO
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-798-3463

Provider Taxonomy Codes

  • Taxonomy code: 246X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6-1835 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8-4330 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com