1568140911 NPI number — MEDICOLEGAL PHYSIATRIST SERVICES PSC

Table of content: (NPI 1568140911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568140911 NPI number — MEDICOLEGAL PHYSIATRIST SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICOLEGAL PHYSIATRIST SERVICES PSC
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:
1568140911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HACIENDA SAN JOSE
Provider Second Line Business Mailing Address:
1450 PUERTA DEL PARQUE
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00727-1383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-672-2264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE E
Provider Second Line Business Practice Location Address:
CENTRO COMERCIAL LOS PRADOS
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-961-0091
Provider Business Practice Location Address Fax Number:
787-961-0045
Provider Enumeration Date:
07/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
CORTES SANTOS
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
OWN
Authorized Official Telephone Number:
787-672-2264

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com