1457764243 NPI number — INTERVENCIONES CREATIVAS

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 1457764243 NPI number — INTERVENCIONES CREATIVAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENCIONES CREATIVAS
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:
INTERVENCIONES CREATIVAS
Provider Other Organization Name Type Code:
4
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:
1457764243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 289-200
Provider Second Line Business Mailing Address:
AVE. RAFAEL CORDERO
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-648-7171
Provider Business Mailing Address Fax Number:
787-961-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
A-5 CALLE 1 ALTOS
Provider Second Line Business Practice Location Address:
URB. CONDADO MODERNO
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-648-7171
Provider Business Practice Location Address Fax Number:
787-961-6086
Provider Enumeration Date:
06/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
CONSEJERO PROFESIONAL -PROPIETARIO
Authorized Official Telephone Number:
787-648-7171

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2294 , 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: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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