Healthcare Provider Details

I. General information

NPI: 1568197119
Provider Name (Legal Business Name): MEJOR SALUD PUERTO RICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-5838
  • Fax: 833-495-7206
Mailing address:
  • Phone: 813-444-5838
  • Fax: 833-495-7206

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: SRIRAM SUNDARAMOORTHY
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 352-622-7000