1518318344 NPI number — 'HORMONES' ENDOCRINOLOGY HEALTH & WELLNESS CLINIC LLC

Table of content: (NPI 1518318344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518318344 NPI number — 'HORMONES' ENDOCRINOLOGY HEALTH & WELLNESS CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
'HORMONES' ENDOCRINOLOGY HEALTH & WELLNESS CLINIC LLC
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:
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NPI Number Information

NPI Number:
1518318344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12331
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:
00914-0331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-901-6198
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 AVE BALDORIOTY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-901-6198
Provider Business Practice Location Address Fax Number:
787-263-0702
Provider Enumeration Date:
06/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ-BERMUDEZ
Authorized Official First Name:
OSCAR
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-901-6198

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  16061 , 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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