1568618056 NPI number — CGD MEDICAL HEALTH SERVICES, P.S.C

Table of content: (NPI 1568618056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568618056 NPI number — CGD MEDICAL HEALTH SERVICES, P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CGD MEDICAL HEALTH SERVICES, P.S.C
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:
1568618056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 6006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARCELONETA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00617-9240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-846-3145
Provider Business Mailing Address Fax Number:
787-846-5969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC 1 BOX 6006
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARCELONETA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00617-9240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-846-3145
Provider Business Practice Location Address Fax Number:
787-846-5969
Provider Enumeration Date:
08/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GIL
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PROPIETARIO
Authorized Official Telephone Number:
787-846-3145

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  16143 , 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)

  • Identifier: 1568618056 . This is a "PTAN HY015A" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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