1518255017 NPI number — LA PERLA DE GRAN PRECIO

Table of content: (NPI 1518255017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518255017 NPI number — LA PERLA DE GRAN PRECIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA PERLA DE GRAN PRECIO
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:
1518255017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 CALLE GAUTIER BENITEZ
Provider Second Line Business Mailing Address:
URB. FLORAL PARK
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-3818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-282-0012
Provider Business Mailing Address Fax Number:
787-759-8821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 816 KM 5.8
Provider Second Line Business Practice Location Address:
SECTOR LOS VARGAS, BARRIO NUEVO
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-730-6375
Provider Business Practice Location Address Fax Number:
787-759-8821
Provider Enumeration Date:
07/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ALONSO
Authorized Official First Name:
LISSETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-645-0649

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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