Provider Demographics
NPI:1710281977
Name:NUBISA
Entity Type:Organization
Organization Name:NUBISA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:YARIS
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LND
Authorized Official - Phone:787-633-0475
Mailing Address - Street 1:H17 AVE MUNOZ MARIN
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6159
Mailing Address - Country:US
Mailing Address - Phone:787-653-9877
Mailing Address - Fax:
Practice Address - Street 1:H17 AVE MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6159
Practice Address - Country:US
Practice Address - Phone:787-653-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service