1982958773 NPI number — RETINA CARE PSC

Table of content: (NPI 1982958773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982958773 NPI number — RETINA CARE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA CARE PSC
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:
1982958773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-2770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-680-7222
Provider Business Mailing Address Fax Number:
787-680-7223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
58 CALLE PONCE DE LEON
Provider Second Line Business Practice Location Address:
URB. GARCIA
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-680-7222
Provider Business Practice Location Address Fax Number:
787-680-7223
Provider Enumeration Date:
11/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
EMANUELLI ANZALOTTA
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-680-7222

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  16978 , 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: LIC MD 16978 . This is a "LIC MD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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