1669797510 NPI number — CLINICA DE TERAPIA VEGA ALTA, CSP

Table of content: (NPI 1669797510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669797510 NPI number — CLINICA DE TERAPIA VEGA ALTA, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE TERAPIA VEGA ALTA, 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:
CENTRO DE TERAPIA INTEGRAL CRECEMOS
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:
1669797510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 CALLE D
Provider Second Line Business Mailing Address:
LAS COLINAS
Provider Business Mailing Address City Name:
VEGA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00692-7112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-270-1854
Provider Business Mailing Address Fax Number:
787-270-1858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 KM 29.4
Provider Second Line Business Practice Location Address:
BO. ESPINOSA
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-270-1854
Provider Business Practice Location Address Fax Number:
787-270-1858
Provider Enumeration Date:
04/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COLON
Authorized Official First Name:
RUZ
Authorized Official Middle Name:
NAHOMI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-270-1854

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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