Healthcare Provider Details

I. General information

NPI: 1053945022
Provider Name (Legal Business Name): DR SUSONI HEALTH COMMUNITY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR, 129 KM 1.0 AVE SAN LUIS
ARECIBO PR
00613-0659
US

IV. Provider business mailing address

PO BOX 659
ARECIBO PR
00613-0659
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-7272
  • Fax: 787-650-7310
Mailing address:
  • Phone: 787-650-7272
  • Fax: 787-650-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN L MEDINA
Title or Position: BILLING AND COLLECTIONS DIRECTOR
Credential:
Phone: 787-650-7272