Provider Demographics
NPI:1710388863
Name:SEBANI GENERAL MEDICINE PRACTITIONERS, P.S.C.
Entity Type:Organization
Organization Name:SEBANI GENERAL MEDICINE PRACTITIONERS, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-851-2625
Mailing Address - Street 1:100 BOQUERON BAY VILLA
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-9735
Mailing Address - Country:US
Mailing Address - Phone:787-851-2625
Mailing Address - Fax:787-851-2625
Practice Address - Street 1:CARR 100 KM 3.6
Practice Address - Street 2:BO GUANAJIBO
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-2625
Practice Address - Fax:787-851-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17832282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR341246Medicare UPIN
PR641234Medicare UPIN