1982903191 NPI number — ALIANZA SICOCOCIAL DE PUERTO RICO

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 1982903191 NPI number — ALIANZA SICOCOCIAL DE PUERTO RICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIANZA SICOCOCIAL DE PUERTO RICO
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:
1982903191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JAUN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-232-5583
Provider Business Mailing Address Fax Number:
787-876-3603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. PR 187 KM 11-1
Provider Second Line Business Practice Location Address:
RESIDENCIAL YUQUIYA
Provider Business Practice Location Address City Name:
LOIZA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-685-5074
Provider Business Practice Location Address Fax Number:
787-876-3603
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COSME
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
ANTONIO
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
787-685-5074

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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