1659484061 NPI number — LABORATORIO CARDIOVASCULAR J.P.,CSP

Table of content: (NPI 1659484061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659484061 NPI number — LABORATORIO CARDIOVASCULAR J.P.,CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CARDIOVASCULAR J.P.,CSP
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:
1659484061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10666
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:
00922-0666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-783-6620
Provider Business Mailing Address Fax Number:
787-793-8444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET 21 NUM. 21 LAS LOMAS
Provider Second Line Business Practice Location Address:
HOSPITAL METROPOLITANO 1FLOOR SUITE 103
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-783-6620
Provider Business Practice Location Address Fax Number:
787-793-8444
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PADILLA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-783-6620

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  8250 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 8250 , 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: 3693 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 069993 . This is a "BLUE CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83349 . This is a "BLUE SHIELD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 600084 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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