1760753701 NPI number — GENESIS INSTITUTO DE SERVICIOS MULTIDISCIPLINARIOS, INC.

Table of content: (NPI 1760753701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760753701 NPI number — GENESIS INSTITUTO DE SERVICIOS MULTIDISCIPLINARIOS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS INSTITUTO DE SERVICIOS MULTIDISCIPLINARIOS, 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:
1760753701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
C1 A4 CONDADO MODERNO
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C1A CALLE 4
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-374-3230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MEDINA
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
IVELISSE
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
787-374-3230

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1914 , 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)





Copyright © 2007-2025 www.npivalidator.com