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NPI Code Detail

MEDICARE: DR. SALLY PRIESTER

MEDICARE: DR. SALLY PRIESTER
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
1208D00000XGeneral Practice Physician16480PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1016480OTHERPRLICENSE

General Provider Information

NPI Number : 1124104260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SALLY PRIESTER
Provider Business Mailing Address
First Line : ASHFORD AVE. 29 WASHINGTON STREET
Second Line : SUITE 608
City : SAN JUAN
State : PR
Zip : 00907-1509
Country : US
Telephone Number : 787-985-9705
Fax Number : 787-957-7087
Provider Business Practice Location Address
First Line : ASHFORD AVE. 29 WASHINGTON STREET
Second Line : SUITE 608
City : SAN JUAN
State : PR
Zip : 00907-1509
Country : US
Telephone Number : 787-985-9705
Fax Number : 787-957-7087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 12/05/2019

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Directions to “ DR. SALLY PRIESTER ” Practice Location

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