1780791814 NPI number — MUNICIPIO DE SABANA GRANDE

Table of content: NICOLE THERIAULT DOUGHTY RD, LD (NPI 1962593665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780791814 NPI number — MUNICIPIO DE SABANA GRANDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUNICIPIO DE SABANA GRANDE
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:
POLICLINICA BERNICE GUERRA
Provider Other Organization Name Type Code:
3
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:
1780791814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 AVE 5 DE DICIEMBRE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SABANA GRANDE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00637-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-873-1755
Provider Business Mailing Address Fax Number:
787-873-2145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 102 KM 39.1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABANA GRANDE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00637-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-873-1755
Provider Business Practice Location Address Fax Number:
787-873-2145
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
ULISES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-873-1755

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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)





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