Provider Demographics
NPI:1962566794
Name:CONSEJO RENAL DE PUERTO RICO
Entity type:Organization
Organization Name:CONSEJO RENAL DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-1500
Mailing Address - Street 1:PO BOX 10542
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-0542
Mailing Address - Country:US
Mailing Address - Phone:787-765-1500
Mailing Address - Fax:787-765-1515
Practice Address - Street 1:#117 ELEANOR ROOSEVELT STREET
Practice Address - Street 2:SUITE 100A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-1500
Practice Address - Fax:787-765-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-0315333600000X
PR09F25563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0230370001Medicare ID - Type UnspecifiedFARMACY
PR0230370001Medicare NSC
PRC08465089Medicare PIN