Healthcare Provider Details

I. General information

NPI: 1588157143
Provider Name (Legal Business Name): PRO HEALTH INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 URB HERMANAS DAVILA MARGINAL CARR 2
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 441
PATILLAS PR
00723-0441
US

V. Phone/Fax

Practice location:
  • Phone: 787-985-1201
  • Fax:
Mailing address:
  • Phone: 787-839-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OSCAR RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-312-5247