1659896959 NPI number — MUNICIPIO DE GUANICA

Table of content: (NPI 1659896959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659896959 NPI number — MUNICIPIO DE GUANICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNICIPIO DE GUANICA
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:
CENTRO DE VACUNACION CDT DE GUANICA
Provider Other Organization Name Type Code:
3
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:
1659896959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUANICA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00653-0785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-821-0402
Provider Business Mailing Address Fax Number:
787-569-4022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 116 INTERIOR KM 27.7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUANICA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00653-0065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-821-0402
Provider Business Practice Location Address Fax Number:
787-569-4022
Provider Enumeration Date:
08/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SEDA
Authorized Official First Name:
SANTOS
Authorized Official Middle Name:
Authorized Official Title or Position:
MAYOR
Authorized Official Telephone Number:
787-821-2777

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1175 . This is a "PUERTO RICO HEALTCARE DEPARTMENT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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