1568447928 NPI number — CIRUGIA AVANZADA DEL OESTE, CSP

Table of content: (NPI 1568447928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568447928 NPI number — CIRUGIA AVANZADA DEL OESTE, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIRUGIA AVANZADA DEL OESTE, CSP
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:
1568447928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7999
Provider Second Line Business Mailing Address:
PMB 352
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-7999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-805-2390
Provider Business Mailing Address Fax Number:
787-805-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE DE DIEGO 55 ESTE
Provider Second Line Business Practice Location Address:
CPR PROFESSIONAL BUILDING, SUITE 202
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-5080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-805-2390
Provider Business Practice Location Address Fax Number:
787-805-1949
Provider Enumeration Date:
12/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
GUASP
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-805-2390

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  13001 , 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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