1760779318 NPI number — CLINICA PEDIATRICA DE TEREPIA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760779318 NPI number — CLINICA PEDIATRICA DE TEREPIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA PEDIATRICA DE TEREPIA, 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:
1760779318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. LA RIVIERA SE 54
Provider Second Line Business Mailing Address:
1283
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-783-6290
Provider Business Mailing Address Fax Number:
787-782-0670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LA RIVIERA S.E. 54
Provider Second Line Business Practice Location Address:
1283
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-783-6290
Provider Business Practice Location Address Fax Number:
787-782-0670
Provider Enumeration Date:
07/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEDINA
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
TERESA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-783-6290

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  611 , 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)