Healthcare Provider Details

I. General information

NPI: 1841104502
Provider Name (Legal Business Name): MONSERRATE MEDICAL CLINIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE 401 BLOQUE 139 4TA EXT. VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

10 CALLE 401 BLOQUE 139 4TA EXT. VILLA CAROLINA
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-5842
  • Fax:
Mailing address:
  • Phone: 787-769-5842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: HIDELBERTO A. BLASCO SARDINAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-769-5842