Healthcare Provider Details

I. General information

NPI: 1518951581
Provider Name (Legal Business Name): AGUADA COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON APARTADO 592
AGUADA PR
00602-3166
US

IV. Provider business mailing address

CALLE COLON # 106 APARTADO 592
AGUADA PR
00602-3166
US

V. Phone/Fax

Practice location:
  • Phone: 787-252-8330
  • Fax: 787-252-8337
Mailing address:
  • Phone: 787-252-8330
  • Fax: 787-252-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number28
License Number StatePR

VIII. Authorized Official

Name: MRS. GLORIA SANCHEZ
Title or Position: FACTURADORA
Credential:
Phone: 787-252-8330