1992100515 NPI number — PROSALUD MEDICAL CENTER P S C

Table of content: (NPI 1992100515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992100515 NPI number — PROSALUD MEDICAL CENTER P S C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSALUD MEDICAL CENTER P S C
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:
1992100515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-1927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-648-9085
Provider Business Mailing Address Fax Number:
787-830-7472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 474 KM 2.2 CALLE FELIPE MENDEZ
Provider Second Line Business Practice Location Address:
BO. COTO
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-648-9085
Provider Business Practice Location Address Fax Number:
787-830-7472
Provider Enumeration Date:
10/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TAVAREZ
Authorized Official First Name:
HUBER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-648-9085

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  TXR , 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)





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