1629518642 NPI number — MORALES GONZALEZ PRIMARY CARE SERVICES INC.

Table of content: (NPI 1629518642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629518642 NPI number — MORALES GONZALEZ PRIMARY CARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORALES GONZALEZ PRIMARY CARE SERVICES INC.
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:
1629518642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 6331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAUCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00698-9712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-415-9877
Provider Business Mailing Address Fax Number:
787-821-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 116 KM 24.7
Provider Second Line Business Practice Location Address:
PLAZA GUANICA
Provider Business Practice Location Address City Name:
GUANICA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-821-0117
Provider Business Practice Location Address Fax Number:
787-821-0117
Provider Enumeration Date:
02/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES PRADO
Authorized Official First Name:
AMILCAR
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
787-408-3471

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1700901097 . This is a "NPI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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