1821354721 NPI number — PRIMARY AND PREVENTIVE MEDICINE PSC

Table of content: (NPI 1821354721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821354721 NPI number — PRIMARY AND PREVENTIVE MEDICINE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY AND PREVENTIVE MEDICINE PSC
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:
1821354721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00694-2277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-644-7043
Provider Business Mailing Address Fax Number:
800-783-9548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA #2, KM 67.7, ZONA INDUSTRIAL
Provider Second Line Business Practice Location Address:
BO. SANTANA
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-644-7043
Provider Business Practice Location Address Fax Number:
800-783-9548
Provider Enumeration Date:
04/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
939-644-7043

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1429 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 17467 , 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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