Healthcare Provider Details

I. General information

NPI: 1245442235
Provider Name (Legal Business Name): POLICLINICA SAN PEDRO REFORMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CALLE MORSE
ARROYO PR
00714-2350
US

IV. Provider business mailing address

PO BOX 818
ARROYO PR
00714-0818
US

V. Phone/Fax

Practice location:
  • Phone: 787-839-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE S RIVERA BADUI
Title or Position: OWNER
Credential: MD
Phone: 787-839-3980