Provider Demographics
NPI:1467546572
Name:GOBIERNO MUNICIPAL DE CIDRA
Entity Type:Organization
Organization Name:GOBIERNO MUNICIPAL DE CIDRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1400
Mailing Address - Street 1:APARTADO 729
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0729
Mailing Address - Country:US
Mailing Address - Phone:787-739-2395
Mailing Address - Fax:787-369-7990
Practice Address - Street 1:SALIDA HOIA AGUAS BUENAS
Practice Address - Street 2:COMPLEJO DEPORTIUO
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0729
Practice Address - Country:US
Practice Address - Phone:787-739-2375
Practice Address - Fax:787-369-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341600000X
PRTC-AMB-2233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRX12163Medicare UPIN
PR0059308Medicare ID - Type Unspecified