1023169034 NPI number — DEPARTAMENTO DE SALUD OFICIAL

Table of content: (NPI 1023169034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023169034 NPI number — DEPARTAMENTO DE SALUD OFICIAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPARTAMENTO DE SALUD OFICIAL
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:
PEDIATRIC RENAL CENTER, UNIVERSITY PEDIATRIC HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1023169034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191079
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-474-0333
Provider Business Mailing Address Fax Number:
787-756-8907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY PEDIATRIC HOSPITAL
Provider Second Line Business Practice Location Address:
CARR 22 BO MONACILLO
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-3232
Provider Business Practice Location Address Fax Number:
787-756-8907
Provider Enumeration Date:
01/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIAZ GUZMAN
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-474-0333

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  34CNC NUM92-168 , 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)