1134106206 NPI number — HOSPITAL MEROPOLITANO DR. TITO MATTEI

Table of content: (NPI 1134106206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134106206 NPI number — HOSPITAL MEROPOLITANO DR. TITO MATTEI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL MEROPOLITANO DR. TITO MATTEI
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:
HOSPITAL SAN LUCAS I DE PONCE
Provider Other Organization Name Type Code:
5
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:
1134106206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
F12 CALLE A
Provider Second Line Business Mailing Address:
JARDINES DE PONCE
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730-1859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-9574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. A
Provider Second Line Business Practice Location Address:
F 12 JARDINES DE PONCE
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-9574
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICO GENERAL
Authorized Official Telephone Number:
787-644-5138

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2580484 , 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: 16204 . This is a "TRIBUNAL EXAMINADOR DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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