1467767079 NPI number — CENTRO DE SERVICIOS MEDICOS INC

Table of content: (NPI 1467767079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467767079 NPI number — CENTRO DE SERVICIOS MEDICOS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE SERVICIOS MEDICOS INC
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:
1467767079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LIZZIE GRAHAM HF16 SEPTIMA SECCION
Provider Second Line Business Mailing Address:
LEVITTOWN
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-795-2935
Provider Business Mailing Address Fax Number:
787-784-0680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LIZZIE GRAHAM HF16 SEPTIMA SECCION
Provider Second Line Business Practice Location Address:
LEVITTOWN
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-795-2935
Provider Business Practice Location Address Fax Number:
787-784-0680
Provider Enumeration Date:
08/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROIG
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-795-4810

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  51 , 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: 51 . This is a "LICENCIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com