1750382743 NPI number — CONDADO HOSPICE PROGRAM, INC

Table of content: DR. ELBA ROSA GONZALEZ BAUZA MD (NPI 1821291212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750382743 NPI number — CONDADO HOSPICE PROGRAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONDADO HOSPICE PROGRAM, INC
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:
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:
1750382743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 CALLE JUAN P DUARTE
Provider Second Line Business Mailing Address:
FLORAL PARK
Provider Business Mailing Address City Name:
HATO REY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-4310
Provider Business Mailing Address Fax Number:
787-758-4315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 CALLE JUAN P DUARTE
Provider Second Line Business Practice Location Address:
FLORAL PARK
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-4310
Provider Business Practice Location Address Fax Number:
787-758-4315
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DE LEON
Authorized Official First Name:
MARIA DE
Authorized Official Middle Name:
LOURDES
Authorized Official Title or Position:
VICE PRESIDENT OF SERVICES
Authorized Official Telephone Number:
787-758-4310

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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