Healthcare Provider Details

I. General information

NPI: 1275573958
Provider Name (Legal Business Name): PROMO SALUD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE CLEMENTE 23-4 VILLA CAROLINA
CAROLINA PR
00983
US

IV. Provider business mailing address

AVE FERNANDEZ JUNCOS BOX 19191
SAN JUAN PR
00910-9191
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-2697
  • Fax: 787-750-2697
Mailing address:
  • Phone: 787-750-2697
  • Fax: 787-750-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA E MELENDEZ
Title or Position: EJECUTIVE DIRECTOR
Credential:
Phone: 787-750-2697