Healthcare Provider Details

I. General information

NPI: 1770317737
Provider Name (Legal Business Name): DEPARTAMENTO DE SALUD DE PUERTO RICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. LUIS COLON SANTOS, CARR.172 KM 0.2, BO TURABO PREDIOS HOSPITAL MENONITA
CAGUAS PR
00726
US

IV. Provider business mailing address

PO BOX 70184
SAN JUAN PR
00936-8184
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-2929
  • Fax:
Mailing address:
  • Phone: 787-765-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DROZ
Title or Position: ADMINISTRATOR
Credential: MHSA
Phone: 787-225-2233