Healthcare Provider Details

I. General information

NPI: 1679746697
Provider Name (Legal Business Name): USCG CLINIC BORINQUEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0002
US

IV. Provider business mailing address

2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0002
US

V. Phone/Fax

Practice location:
  • Phone: 787-890-8477
  • Fax: 787-890-8481
Mailing address:
  • Phone: 787-890-8477
  • Fax: 787-890-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS M RIVERA
Title or Position: CHIEF HEALTH SERVICES DIVISION
Credential: MD
Phone: 787-890-8477