1861402463 NPI number — POLICLINICA DIAZ ARANA

Table of content: DAN ROBERT BODISON JR. MD (NPI 1215937610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861402463 NPI number — POLICLINICA DIAZ ARANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POLICLINICA DIAZ ARANA
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:
1861402463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250612
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00604-0612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-2055
Provider Business Mailing Address Fax Number:
787-882-2055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. CEIBA BAJA
Provider Second Line Business Practice Location Address:
CARR. 110 KM 0.9
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-2055
Provider Business Practice Location Address Fax Number:
787-882-2055
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-882-2055

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  10782 , 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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