Healthcare Provider Details

I. General information

NPI: 1710281977
Provider Name (Legal Business Name): NUBISA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H17 AVE MUNOZ MARIN
CAGUAS PR
00725-6159
US

IV. Provider business mailing address

H17 AVE MUNOZ MARIN
CAGUAS PR
00725-6159
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-9877
  • Fax:
Mailing address:
  • Phone: 787-653-9877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRTA YARIS RODRIGUEZ
Title or Position: PRESIDENT
Credential: LND
Phone: 787-633-0475