1578801247 NPI number — VASCULAR INTERVENTIONAL DIAGNOSTIC ASSOCIATES PSC

Table of content: (NPI 1578801247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578801247 NPI number — VASCULAR INTERVENTIONAL DIAGNOSTIC ASSOCIATES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR INTERVENTIONAL DIAGNOSTIC ASSOCIATES 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:
1578801247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 364164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-4164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-705-8675
Provider Business Mailing Address Fax Number:
787-705-8676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GUAYNABO MEDICAL MALL
Provider Second Line Business Practice Location Address:
SUITE 208 B # 140 AVENIDA LAS CUMBRES
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-705-8675
Provider Business Practice Location Address Fax Number:
787-705-8676
Provider Enumeration Date:
01/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
NEVELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-599-2166

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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