1669079000 NPI number — CBV MANAGEMENT

Table of content: (NPI 1669079000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669079000 NPI number — CBV MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CBV MANAGEMENT
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:
1669079000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1438
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COROZAL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00783-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-348-4179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 159 # KM13.9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-6140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
NIEVES
Authorized Official First Name:
JULISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
GERENTE GENERAL
Authorized Official Telephone Number:
787-348-4179

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20-073 . This is a "CERTIFICADO DE NECESIDAD Y CONVENIENCIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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