1508997479 NPI number — GES CDT DR JOSE A LOPEZ ANTONGIORGI

Table of content: (NPI 1508997479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508997479 NPI number — GES CDT DR JOSE A LOPEZ ANTONGIORGI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GES CDT DR JOSE A LOPEZ ANTONGIORGI
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:
1508997479
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 193044
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-3044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-8758
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CALLE NE 333
Provider Second Line Business Practice Location Address:
PUERTO NUEVO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-793-8989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VILLALOBOS
Authorized Official First Name:
RAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-767-8758

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  08F2460 , 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: NCPDP4023103 . This is a "PHARMACY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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