Healthcare Provider Details

I. General information

NPI: 1770165326
Provider Name (Legal Business Name): SERVICIOS MEDICOS DR. ANTONIO DECLET, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2337
US

IV. Provider business mailing address

20 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2337
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-4476
  • Fax: 787-829-4946
Mailing address:
  • Phone: 787-829-4476
  • Fax: 787-829-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTONIO DECLET
Title or Position: PRESIDENT
Credential: MD
Phone: 787-829-4476