Healthcare Provider Details

I. General information

NPI: 1972509842
Provider Name (Legal Business Name): SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY NO. 2, CRUCE DAVILA, KM. 57.8
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 2045
BARCELONETA PR
00617-2045
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4412
  • Fax: 787-846-7410
Mailing address:
  • Phone: 787-846-4412
  • Fax: 787-846-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number00079
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LEIDA A. NAZARIO
Title or Position: EXECUTIVE DIRECTOR
Credential: MHSA
Phone: 787-846-4412