1437295094 NPI number — FARMACIA LAGO VISTA INC CALLE CAYMAN

Table of content: (NPI 1437295094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437295094 NPI number — FARMACIA LAGO VISTA INC CALLE CAYMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FARMACIA LAGO VISTA INC CALLE CAYMAN
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:
1437295094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51063
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00950-1063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-784-4585
Provider Business Mailing Address Fax Number:
787-795-1465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE BLVD 3386 LEVITTOWN
Provider Second Line Business Practice Location Address:
PASEO CARMEN 3385-86
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-784-4585
Provider Business Practice Location Address Fax Number:
787-795-1465
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
VICMARIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
787-784-4585

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 19F0278 , 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)

  • Identifier: 2084147 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com