Healthcare Provider Details

I. General information

NPI: 1124231246
Provider Name (Legal Business Name): IPA POLICLINICA VILLA LOS SANTOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. VILLA LOS SANTOS CALLE 16 V-1
ARECIBO PR
00612
US

IV. Provider business mailing address

URB. VILLA LOS SANTOS CALLE 16 V-1
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-879-1585
  • Fax: 787-879-4315
Mailing address:
  • Phone: 787-879-1585
  • Fax: 787-879-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN MELENDEZ ACEVEDO
Title or Position: SUPERVISOR
Credential: REGISTER NURSE
Phone: 787-879-1585