1497890321 NPI number — CORPORACION MEDICA DE JUANA DIAZ, INC.

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 1497890321 NPI number — CORPORACION MEDICA DE JUANA DIAZ, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORACION MEDICA DE JUANA DIAZ, 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:
1497890321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1422
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUANA DIAZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00795-1422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-260-0447
Provider Business Mailing Address Fax Number:
787-260-6147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MUNOZ RIVERA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUANA DIAZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-260-0447
Provider Business Practice Location Address Fax Number:
787-260-6147
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTERO
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
JUAN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-260-0447

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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