Healthcare Provider Details

I. General information

NPI: 1568794758
Provider Name (Legal Business Name): MUNICIPIO DE BAYAMON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ISABEL II ESQUINA DEGETAU
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 1588
BAYAMON PR
00960-1588
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-7565
  • Fax: 787-269-5230
Mailing address:
  • Phone: 787-269-7565
  • Fax: 787-269-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number26
License Number StatePR

VIII. Authorized Official

Name: MRS. DEBORAH D MEDINA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-269-7565