1417722372 NPI number — ASSERTIVE SURGICAL NETWORK, LLC

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 1417722372 NPI number — ASSERTIVE SURGICAL NETWORK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSERTIVE SURGICAL NETWORK, LLC
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:
1417722372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 CALLE FELIPE SEGUNDO
Provider Second Line Business Mailing Address:
MANSION REAL
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-415-1142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 CALLE OBISPADO
Provider Second Line Business Practice Location Address:
URB. JARDINES FAGOT
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-813-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PAGAN
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
787-813-1010

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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