1699005447 NPI number — LORAN CORP

Table of content: (NPI 1699005447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699005447 NPI number — LORAN CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORAN CORP
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:
1699005447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 CALLE GARZA
Provider Second Line Business Mailing Address:
URB BRISAS DEL PRADO
Provider Business Mailing Address City Name:
SANTA ISABEL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00757-2560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-845-2000
Provider Business Mailing Address Fax Number:
787-845-2000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO JAUCA 2 SECTOR USERAS
Provider Second Line Business Practice Location Address:
CARR 153 KM 3 HM 2
Provider Business Practice Location Address City Name:
SANTA ISABEL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-845-2000
Provider Business Practice Location Address Fax Number:
787-845-2000
Provider Enumeration Date:
12/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
LORNA
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-677-2000

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  11-F-2761 , 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: 11-F-2761 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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