1427339316 NPI number — CDMA MEDICAL CORPORATION, PSC

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 1427339316 NPI number — CDMA MEDICAL CORPORATION, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CDMA MEDICAL CORPORATION, PSC
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:
1427339316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE JESUS T PINERO 282
Provider Second Line Business Mailing Address:
PLAZA EL AMAL SUITE 204
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-751-7799
Provider Business Mailing Address Fax Number:
787-296-8447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE JESUS T PINERO # 282
Provider Second Line Business Practice Location Address:
PLAZA EL AMAL SUITE 204
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-751-7799
Provider Business Practice Location Address Fax Number:
787-296-8447
Provider Enumeration Date:
09/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HERGER
Authorized Official First Name:
ERNESTO
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-751-7799

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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