1679122931 NPI number — COROZAL VISION CARE, LLC

Table of content: (NPI 1679122931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679122931 NPI number — COROZAL VISION CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COROZAL VISION CARE, LLC
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:
1679122931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 634
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:
00783-0634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-621-3700
Provider Business Mailing Address Fax Number:
787-621-3762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO COMERCIAL SHOPPING VILLAGE
Provider Second Line Business Practice Location Address:
CARR 159 KM 13.2
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-621-3700
Provider Business Practice Location Address Fax Number:
787-621-3762
Provider Enumeration Date:
09/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NARVAEZ
Authorized Official First Name:
PEDRO
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR CONTRATACIONES
Authorized Official Telephone Number:
787-621-3700

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com