1790057339 NPI number — S & S MEDICAL GROUP, P.S.C.

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 1790057339 NPI number — S & S MEDICAL GROUP, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & S MEDICAL GROUP, P.S.C.
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:
1790057339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MONTE ATENAS
Provider Second Line Business Mailing Address:
RR 36 BOX 36
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-7807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-300-1175
Provider Business Mailing Address Fax Number:
787-723-1736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE DEL METROPOLITANO
Provider Second Line Business Practice Location Address:
CARR 21 # 1789 LAS LOMAS SUITE # 305
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-594-1785
Provider Business Practice Location Address Fax Number:
787-723-1736
Provider Enumeration Date:
01/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ABREU GONZALEZ
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-300-1175

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  15170 , 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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