Healthcare Provider Details

I. General information

NPI: 1568782498
Provider Name (Legal Business Name): SOUTHWEST HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 INT VICTOR ROJAS 2
ARECIBO PR
00612
US

IV. Provider business mailing address

PO BOX 9976 COTTO STATION
ARECIBO PR
00613-9976
US

V. Phone/Fax

Practice location:
  • Phone: 787-650-0020
  • Fax: 787-650-0100
Mailing address:
  • Phone: 787-650-0090
  • Fax: 787-650-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number40
License Number StatePR

VIII. Authorized Official

Name: MRS. VIVIAN SOLIVAN
Title or Position: ADMINISTRATOR
Credential: LIC
Phone: 787-650-0090