Provider Demographics
NPI:1629405287
Name:EMBATA CORP.
Entity Type:Organization
Organization Name:EMBATA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:GOYECHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:78737-396-6466
Mailing Address - Street 1:J 6 CALLE 2 URB. BRISAS DEL MAR
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773
Mailing Address - Country:US
Mailing Address - Phone:787-355-1222
Mailing Address - Fax:
Practice Address - Street 1:6410 AVE ISLA VERDE APT 4 L ESTE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-373-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty