1871060178 NPI number — SERVICIOS PRO MEDICO

Table of content: (NPI 1871060178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871060178 NPI number — SERVICIOS PRO MEDICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS PRO MEDICO
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:
1871060178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-0114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-590-7238
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB MENDEZ A2
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
YABUCOA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-590-7238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
MELVIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-590-7238

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com