Healthcare Provider Details

I. General information

NPI: 1548273337
Provider Name (Legal Business Name): SOUTHWEST HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE MUNOZ RIVERA
CABO ROJO PR
00623-4060
US

IV. Provider business mailing address

PO BOX 910
CABO ROJO PR
00623-0910
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-2025
  • Fax: 787-254-0235
Mailing address:
  • Phone: 787-851-2025
  • Fax: 787-254-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number380
License Number StatePR

VIII. Authorized Official

Name: MR. LEONARDO COLON MALDONADO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 787-851-4505