1992094981 NPI number — PEKES EN DESARROLLO

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 1992094981 NPI number — PEKES EN DESARROLLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEKES EN DESARROLLO
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:
1992094981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 MARGINAL LAGO ALTO
Provider Second Line Business Mailing Address:
PLAZA SAN MIGUEL 207
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-3906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-2534
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 MARGINAL LAGO ALTO
Provider Second Line Business Practice Location Address:
PLAZA SAN MIGUEL 207
Provider Business Practice Location Address City Name:
TRUJILLO ALTO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00976-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-292-2534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAVILAN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTORA CLINICA/T.O
Authorized Official Telephone Number:
787-292-2534

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  689 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X , with the licence number: 810 , 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)