1578503116 NPI number — FARES A CID MANSUR M.D.

Table of content: FARES A CID MANSUR M.D. (NPI 1578503116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578503116 NPI number — FARES A CID MANSUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CID MANSUR
Provider First Name:
FARES
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1578503116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 383609
Provider Second Line Business Mailing Address:
AVE TITO CASTRO SUITE 102
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-812-1210
Provider Business Mailing Address Fax Number:
787-812-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE ACACIA EDIFICIO MICHELLE PLAZA SECTOR VILLA FLORE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-812-1210
Provider Business Practice Location Address Fax Number:
787-812-1211
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  10164 , 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: 220220 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3603 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8000285 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: M399 . This is a "PLAN MENONITA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 01133 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 602066 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2095 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83133 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8000285 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 060853 . This is a "CRUZ AZUL DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 37225 . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: P00160427 . This is a "PA;METTO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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