Healthcare Provider Details

I. General information

NPI: 1396813549
Provider Name (Legal Business Name): SERVICIOS DE SALUD PRIMARIOS DE BARCELONETA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KIL 57.8 CRUCE DAVILA
BARCELONETA PR
00617-2045
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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier985
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

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