1881254498 NPI number — WESTERN MEDICAL GROUP P.S.C.

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 1881254498 NPI number — WESTERN MEDICAL GROUP P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MEDICAL GROUP P.S.C.
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:
1881254498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 11465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-9770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-896-5738
Provider Business Mailing Address Fax Number:
787-896-5738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA ANIDEM SUITE 3
Provider Second Line Business Practice Location Address:
CARR 447 KM 3.9 BARRIO AIBONITO
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-9770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-5738
Provider Business Practice Location Address Fax Number:
787-896-5738
Provider Enumeration Date:
06/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ RUIZ
Authorized Official First Name:
CRISTOBAL
Authorized Official Middle Name:
I
Authorized Official Title or Position:
DIRECTOR MEDICO / PRESIDENTE
Authorized Official Telephone Number:
787-896-5738

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)

  • Identifier: 421056 . This is a "REGISTRO DEPARTAMENTO DE ESTADO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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