Provider Demographics
NPI:1285058198
Name:BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO
Entity type:Organization
Organization Name:BANCO DE OJOS DEL LEONISMO PUERTORRIQUENO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-273-0597
Mailing Address - Street 1:PO BOX 363311
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3311
Mailing Address - Country:US
Mailing Address - Phone:787-273-0597
Mailing Address - Fax:407-499-4655
Practice Address - Street 1:V3-22 AVE SAN ALFONSO
Practice Address - Street 2:URB. LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3608
Practice Address - Country:US
Practice Address - Phone:787-273-0597
Practice Address - Fax:407-499-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7349332G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332G00000XSuppliersEye Bank
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7349OtherINCORPORATED REGISTER #7349