1811218407 NPI number — BARCELONETA PRIMARY HEALTH SERVICES INC. (CLINIC NUTRICIONAL)

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 1811218407 NPI number — BARCELONETA PRIMARY HEALTH SERVICES INC. (CLINIC NUTRICIONAL)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARCELONETA PRIMARY HEALTH SERVICES INC. (CLINIC NUTRICIONAL)
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:
ATLANTIC MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1811218407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2045
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARCELONETA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00617-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-784-6441
Provider Business Mailing Address Fax Number:
178-784-6741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR #2 KM 57.8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARCELONETA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00617-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
178-784-6441
Provider Business Practice Location Address Fax Number:
178-784-6741
Provider Enumeration Date:
06/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NAZARIO
Authorized Official First Name:
LEIDA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
17878464412

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , 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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