1497168124 NPI number — PROFESSIONAL MEDICAL CENTER

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 1497168124 NPI number — PROFESSIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL MEDICAL CENTER
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:
1497168124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
698 VEREDAS LOS CEDROS
Provider Second Line Business Mailing Address:
URB. VEREDAS DE NAVARRO
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-6098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-743-1985
Provider Business Mailing Address Fax Number:
787-744-6276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 931 KM 5.5
Provider Second Line Business Practice Location Address:
PRADERAS SHOPPING CENTER
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-1985
Provider Business Practice Location Address Fax Number:
787-744-6276
Provider Enumeration Date:
06/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CORDERO SEPULVEDA
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-743-1985

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  16022 , 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: 332572 . This is a "REGISTER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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