1154104511 NPI number — CLINICA SALUD PRIMARIA DE ARECIBO LLC

Table of content: SAKURA M NODA MD (NPI 1710393541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154104511 NPI number — CLINICA SALUD PRIMARIA DE ARECIBO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA SALUD PRIMARIA DE ARECIBO LLC
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:
1154104511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 URB LOS AIRES SERENOS
Provider Second Line Business Mailing Address:
HELIO STREET
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00612-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-616-4736
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 2 KM 81.5 AVE. MIRAMAR
Provider Second Line Business Practice Location Address:
1602 SUITE 2
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-680-1211
Provider Business Practice Location Address Fax Number:
787-680-4036
Provider Enumeration Date:
08/17/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ OCANA
Authorized Official First Name:
ALVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
787-680-1211

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134634389 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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