1871623108 NPI number — CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,INC

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 1871623108 NPI number — CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAS EXTERNA CENTRO ACADEMICO SAN JUAN BAUTISTA,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:
6
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:
1871623108
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:
SALIDA 21 CARRETERA 172
Provider Second Line Business Mailing Address:
P.O. BOX 4968
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-4968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-774-3303
Provider Business Mailing Address Fax Number:
787-746-3093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SALIDA 21 CARRETERA 172
Provider Second Line Business Practice Location Address:
TURABO GARDEN
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
178-774-3303
Provider Business Practice Location Address Fax Number:
787-746-3093
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRUGAL
Authorized Official First Name:
YOCASTA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
17877433038

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , 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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