MEDICARE: SERVICIOS DE SALUD DEL OESTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1003380247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICIOS DE SALUD DEL OESTE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1562
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-1562
Country	:	US
Telephone Number	:	787-818-1405
Fax Number	:	787-818-1401

Provider Business Practice Location Address
First Line	:	65 CALLE PEDRO SANTOS
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4015
Country	:	US
Telephone Number	:	787-818-1405
Fax Number	:	787-818-1401

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAVID A GONZALEZ
Credential	:
Telephone Number	:	787-692-5598

Provider Enumeration Date	:	01/21/2019
Last Update Date	:	01/21/2019

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