Healthcare Provider Details

I. General information

NPI: 1295860633
Provider Name (Legal Business Name): SOUTHWEST HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
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

MUNOZ RIVERA STREET NUM. 108 P.O. 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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09F1760
License Number StatePR

VIII. Authorized Official

Name: MR. ANGEL LUIS VARGAS
Title or Position: MBAHCM
Credential:
Phone: 787-851-2025