Healthcare Provider Details

I. General information

NPI: 1255675377
Provider Name (Legal Business Name): CLINICA DE SALUD Y PREVENCION DE ANASCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ESQUINA IBANEZ CALLE SAN ANTONIO
ANASCO PR
00610-0014
US

IV. Provider business mailing address

PO BOX 171
MAYAGUEZ PR
00681-0171
US

V. Phone/Fax

Practice location:
  • Phone: 469-432-3837
  • Fax:
Mailing address:
  • Phone: 469-432-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number503
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number401
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE NEGRON
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 469-432-3837