Healthcare Provider Details

I. General information

NPI: 1619236171
Provider Name (Legal Business Name): NEFROLOGY & MEDICAL SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE SANTA CRUZ SUITE 503 INSTITUTO SAN PABLO
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

PO BOX 9220
BAYAMON PR
00960-9220
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-1011
  • Fax: 787-740-1008
Mailing address:
  • Phone: 787-740-1011
  • Fax: 787-740-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number8838
License Number StatePR

VIII. Authorized Official

Name: DR. EDWIN A MORA-RUIZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-740-1011