1699878017 NPI number — DR. CARLOS ALBERTO GONZALEZ-BERDECIA

Table of content: DR. CARLOS ALBERTO GONZALEZ-BERDECIA (NPI 1699878017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699878017 NPI number — DR. CARLOS ALBERTO GONZALEZ-BERDECIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ-BERDECIA
Provider First Name:
CARLOS
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1699878017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-7503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-840-3510
Provider Business Mailing Address Fax Number:
787-840-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LAS DELICIAS
Provider Second Line Business Practice Location Address:
1204 CALLE FCO. VASALLO
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00728-3838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-3510
Provider Business Practice Location Address Fax Number:
787-840-3510
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  6748 , 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: 27891GO . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 061882 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 200049 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7320071 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2881 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 3606748 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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