Healthcare Provider Details

I. General information

NPI: 1699213041
Provider Name (Legal Business Name): SERVICIOS CLINICOS DEL ESTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 190 KM 1.8 BOCA CANGREJO
CAROLINA PR
00983
US

IV. Provider business mailing address

41 URB COSTA VERDE PALMAS DEL MAR
HUMACAO PR
00791-6037
US

V. Phone/Fax

Practice location:
  • Phone: 787-646-7769
  • Fax:
Mailing address:
  • Phone:
  • 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: ISMARY M GONZALEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-646-7769