1952312324 NPI number — CONSULTORIO OPTOMETRICO DE SG, CSP

Table of content: (NPI 1952312324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952312324 NPI number — CONSULTORIO OPTOMETRICO DE SG, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTORIO OPTOMETRICO DE SG, CSP
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:
1952312324
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:
PO BOX 495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN GERMAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00683-0495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-892-1218
Provider Business Mailing Address Fax Number:
787-892-7480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. ANGEL C PEREZ #2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-1218
Provider Business Practice Location Address Fax Number:
787-892-7480
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORA
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OPTOMETRIST/PRESIDENT
Authorized Official Telephone Number:
787-892-1218

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  403-0029 , 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)

  • Identifier: 50002 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5211 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6830042 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890343 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 077-137 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 215264 . This is a "PREFFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com