1578902193 NPI number — PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL

Table of content: (NPI 1578902193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578902193 NPI number — PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL
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:
6
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:
1578902193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
METRO OFFICE PARK
Provider Second Line Business Mailing Address:
18 CALLE 1 STE 400
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-774-3344
Provider Business Mailing Address Fax Number:
787-774-6253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
METRO OFFICE PARK
Provider Second Line Business Practice Location Address:
18 CALLE 1 STE 400
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-774-3344
Provider Business Practice Location Address Fax Number:
787-774-6253
Provider Enumeration Date:
06/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RESTO TORRES
Authorized Official First Name:
BILL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
787-774-3344

Provider Taxonomy Codes

  • Taxonomy code: 310500000X , with the licence number:  10-CNCNUM.05-298 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 10-CNCNUM.05-298 , 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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