Healthcare Provider Details

I. General information

NPI: 1770058398
Provider Name (Legal Business Name): SANA ACCOUNTABLE CARE ORGANIZATION OF PUERTO RICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-6120
  • Fax: 787-625-6124
Mailing address:
  • Phone: 787-625-6120
  • Fax: 787-625-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ILIA ESTHER ZAYAS -TORO
Title or Position: DIRECTOR
Credential: MD
Phone: 787-625-6120