1598096026 NPI number — HATO REY HEALTH CLINIC PHG

Table of content: (NPI 1598096026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598096026 NPI number — HATO REY HEALTH CLINIC PHG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HATO REY HEALTH CLINIC PHG
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:
1598096026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 CALLE CALAF STE 361
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:
00918-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-993-3535
Provider Business Mailing Address Fax Number:
787-522-0649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 CALLE JUAN CALAF
Provider Second Line Business Practice Location Address:
STE #3
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-282-7788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO RIVERA
Authorized Official First Name:
IDALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-368-9787

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  15502 , 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: 660638103 . This is a "OPTION HEALTH GROUP, INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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