1922302868 NPI number — OPTICA CDTGMSP

Table of content: (NPI 1922302868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922302868 NPI number — OPTICA CDTGMSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTICA CDTGMSP
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:
1922302868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
B-7 SANTA CRUZ
Provider Second Line Business Mailing Address:
URB SANTA CRUZ
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
B-7 SANTA CRUZ
Provider Second Line Business Practice Location Address:
URB SANTA CRUZ
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-9316
Provider Business Practice Location Address Fax Number:
787-778-2281
Provider Enumeration Date:
01/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ZAYAS
Authorized Official First Name:
ILIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-780-9196

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038436400 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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