1487029450 NPI number — LABORATORIOS DEL SUENO DE PUERTO RICO

Table of content: (NPI 1487029450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487029450 NPI number — LABORATORIOS DEL SUENO DE PUERTO RICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIOS DEL SUENO DE PUERTO RICO
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:
1487029450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CALLE DE DIEGO E STE 405
Provider Second Line Business Mailing Address:
CPR PROF. BLDG
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-5082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-778-5957
Provider Business Mailing Address Fax Number:
787-778-5958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 CARR 2 STE 703
Provider Second Line Business Practice Location Address:
ROAD #2
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-986-7010
Provider Business Practice Location Address Fax Number:
787-805-4477
Provider Enumeration Date:
12/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OTERO
Authorized Official First Name:
IVETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
787-986-7010

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  516492 , 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)





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