Provider Demographics
NPI:1427667906
Name:NORTHWESTERN RENAL CARE PSC
Entity type:Organization
Organization Name:NORTHWESTERN RENAL CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-639-0557
Mailing Address - Street 1:HC 61 BOX 5400
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9534
Mailing Address - Country:US
Mailing Address - Phone:939-639-0557
Mailing Address - Fax:787-877-3516
Practice Address - Street 1:EDIFICIO WESTERN PLAZA, OFICINA 10
Practice Address - Street 2:AVE. SEVERIANO CUEVAS 18, CARR 460 KM 1.2 INT
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:939-639-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization