Healthcare Provider Details

I. General information

NPI: 1003218637
Provider Name (Legal Business Name): POLICLINICA DEL CARIBE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CALLE PISCIS LOS ANGELES
CAROLINA PR
00979-1620
US

IV. Provider business mailing address

PO BOX 3677
CAROLINA PR
00984-3677
US

V. Phone/Fax

Practice location:
  • Phone: 787-791-5712
  • Fax: 787-253-3689
Mailing address:
  • Phone: 787-791-5712
  • Fax: 787-253-3689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5572
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE LUIS MENDEZ SANTIAGO
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-791-5712