1801290747 NPI number — DAMAR OF PUERTO RICO SERVICES 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 1801290747 NPI number — DAMAR OF PUERTO RICO SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAMAR OF PUERTO RICO SERVICES 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:
6
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:
1801290747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00928-5130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-982-8300
Provider Business Mailing Address Fax Number:
787-982-8300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE FLOR ANTILLANA
Provider Second Line Business Practice Location Address:
RES. LUIS LLORENS TORRES
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-982-8300
Provider Business Practice Location Address Fax Number:
787-982-8300
Provider Enumeration Date:
10/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CAO
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
786-547-3240

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  17-F-3155 , 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)

  • Identifier: 2149694 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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