Healthcare Provider Details

I. General information

NPI: 1780010561
Provider Name (Legal Business Name): SERVICIOS MEDICOS DE ANASCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET IBANEZ 14
ANASCO PR
00610
US

IV. Provider business mailing address

14 CALLE SAN ANTONIO
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-8082
  • Fax:
Mailing address:
  • Phone: 787-826-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number14378
License Number StatePR

VIII. Authorized Official

Name: JACQUELINE MENDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-826-8082