Healthcare Provider Details

I. General information

NPI: 1588637789
Provider Name (Legal Business Name): AGUADILLA MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AVE VICTORIA
AGUADILLA PR
00603-4728
US

IV. Provider business mailing address

PO BOX 250479
AGUADILLA PR
00604-0479
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-0303
  • Fax: 787-997-1680
Mailing address:
  • Phone: 787-882-0303
  • Fax: 787-997-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number22
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number864
License Number StatePR

VIII. Authorized Official

Name: MRS. BETHZAIDA LOPEZ
Title or Position: SUPERVISOR
Credential:
Phone: 787-882-0303