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General NPI Number Information
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NPI Number | 1376990499
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Entity Type | Organization
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Legal Business Name | COOPERATIVA COLOMBIANA DE CONDUCTORES, INC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 10920 CORONA AVE
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City | CORONA
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State | NY
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Zip | 11368-3943
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Country | US
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Telephone | 718-699-0960
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Fax | 718-271-9220
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Provider Business Mailing Address
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Address Line | 109-20 CORONA AVE
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-699-0960
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Fax | 718-271-9220
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTONIO DIAZ SR.
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Credential |
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Telephone | 718-699-0960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number | B01124
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License Number State | NY
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