Healthcare Provider Details

I. General information

NPI: 1770740557
Provider Name (Legal Business Name): ATENCION MEDICA INMEDIATA CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA RAFAEL CORDERO RAFAEL CORDERO #28
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 193477
SAN JUAN PR
00919-3477
US

V. Phone/Fax

Practice location:
  • Phone: 787-258-7020
  • Fax: 787-258-7021
Mailing address:
  • Phone: 787-286-6060
  • Fax: 787-286-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1056
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE A RIVERA ORTIZ
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 787-286-6060