1730544081 NPI number — CENTRO DE SALUD CONDUCTUAL MENONITA

Table of content: (NPI 1730544081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730544081 NPI number — CENTRO DE SALUD CONDUCTUAL MENONITA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE SALUD CONDUCTUAL MENONITA
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:
CLINICA AMBULATORIA DE OROCOVIS
Provider Other Organization Name Type Code:
5
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:
1730544081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 372800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-434-1700
Provider Business Mailing Address Fax Number:
787-535-1114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CALLE HOSPITAL CARRETERA 155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROCOVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00720-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-434-1700
Provider Business Practice Location Address Fax Number:
787-595-1114
Provider Enumeration Date:
12/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
LISSETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
787-434-1700

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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