Healthcare Provider Details

I. General information

NPI: 1518159334
Provider Name (Legal Business Name): ALFREDO L. ESCALERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE MAR DEL CORAL VILLAMAR
CAROLINA PR
00979-6341
US

IV. Provider business mailing address

178 5TH STREET VILLAMAR
CAROLINA PR
00979-0979
US

V. Phone/Fax

Practice location:
  • Phone: 787-531-9290
  • Fax:
Mailing address:
  • Phone: 787-531-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number10436
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: