1922713395 NPI number — CENTRO OFTALMOLOGICO SAN ANGEL

Table of content: (NPI 1922713395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922713395 NPI number — CENTRO OFTALMOLOGICO SAN ANGEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO OFTALMOLOGICO SAN ANGEL
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:
1922713395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 WESTOVER DR # 19593
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27330-8941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-449-7799
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE SANTA MONICA 430-435
Provider Second Line Business Practice Location Address:
COL EL SANTUARIO
Provider Business Practice Location Address City Name:
GUADALAJARA
Provider Business Practice Location Address State Name:
MX
Provider Business Practice Location Address Postal Code:
44200
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
888-449-7799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EZQUERRA
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
888-449-7799

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 56738497905909 . This is a "STATE" identifier . This identifiers is of the category "OTHER".