1568087922 NPI number — SGMJ MEDICAL CARE LLC

Table of content: (NPI 1568087922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568087922 NPI number — SGMJ MEDICAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SGMJ MEDICAL CARE 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:
1568087922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4952
Provider Second Line Business Mailing Address:
SIUTE 343
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-732-7424
Provider Business Mailing Address Fax Number:
787-732-7424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 CALLE MUNOZ RIVERA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUAS BUENAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00703-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-732-7424
Provider Business Practice Location Address Fax Number:
787-732-7424
Provider Enumeration Date:
06/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BONILLA GONZALEZ
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL PRACTICE
Authorized Official Telephone Number:
787-378-4017

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 823035 . This is a "DRIVER LINCEN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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