Healthcare Provider Details

I. General information

NPI: 1811395395
Provider Name (Legal Business Name): ISLOTE MEDICAL SOLUTIONS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 681 KM 4.4 BARRIO ISLOTE
ARECIBO PR
00612
US

IV. Provider business mailing address

CARR 681 # KM4.4 BO. ISLOTE
ARECIBO PR
00612-5313
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-0948
  • Fax: 787-881-5073
Mailing address:
  • Phone: 787-881-5073
  • Fax: 787-878-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberCB-0712
License Number StatePR

VIII. Authorized Official

Name: DR. GILBERT RODRIGUEZ JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: TAC-III-05-20-2051
Phone: 787-636-5443