1821369257 NPI number — MEDICA MOVIL DE PUERTO RICO INC.

Table of content: (NPI 1821369257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821369257 NPI number — MEDICA MOVIL DE PUERTO RICO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICA MOVIL DE PUERTO RICO 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:
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:
1821369257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1806
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RINCON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00677-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-3171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR.441 KM 0.6 BO. GUANIQUILLA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602-9742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-868-3171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
ALEXIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-868-3171

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC-AMB-697 , 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: TC-AMB-697 . This is a "CSP OF PUERTO RICO LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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