Provider Demographics
NPI:1437411832
Name:NADD MEDICAL CSP
Entity Type:Organization
Organization Name:NADD MEDICAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-8977
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:PMB 844
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-765-8977
Mailing Address - Fax:787-282-6059
Practice Address - Street 1:1002 CALLE 44 SE
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2719
Practice Address - Country:US
Practice Address - Phone:787-765-8977
Practice Address - Fax:787-282-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82371Medicare PIN