1528124476 NPI number — BCW PUERTO RICO, LLC

Table of content: (NPI 1528124476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528124476 NPI number — BCW PUERTO RICO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BCW PUERTO RICO, 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:
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:
1528124476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 8, AA-6
Provider Second Line Business Mailing Address:
URB. LAS VEGAS
Provider Business Mailing Address City Name:
CATANO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-275-1919
Provider Business Mailing Address Fax Number:
787-275-1882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LAS VEGAS FF-20 CALLE 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATANO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-275-1919
Provider Business Practice Location Address Fax Number:
787-275-1882
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PACHECO
Authorized Official First Name:
SIXTO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
787-275-1919

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1095 , 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)