Healthcare Provider Details
I. General information
NPI: 1801050596
Provider Name (Legal Business Name): BAYAMON HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
STREET MANUEL F. ROSSY, ESQ. ISABEL II
BAYAMON PR
00960-2759
US
IV. Provider business mailing address
PO BOX 2759
BAYAMON PR
00960-2759
US
V. Phone/Fax
- Phone: 787-995-1911
- Fax: 787-798-0340
- Phone: 787-995-1911
- Fax: 787-798-0340
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QD0000X |
| Taxonomy | Dental Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MISS
TAMARA
BEHAR
YBARRA
Title or Position: DIRECTOR EXECUTIVE
Credential: MD
Phone: 787-995-1911