Provider Demographics
NPI:1194960781
Name:NEFROLOGIA COSTA NORTE CSP
Entity type:Organization
Organization Name:NEFROLOGIA COSTA NORTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:AREVALO ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-816-5783
Mailing Address - Street 1:P.O. BOX 144035
Mailing Address - Street 2:PMB 503
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-816-5783
Mailing Address - Fax:787-816-5783
Practice Address - Street 1:ANTONIO R BARCELO 163
Practice Address - Street 2:SUITE 104
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-5783
Practice Address - Fax:787-816-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROO20039Medicare PIN