Healthcare Provider Details

I. General information

NPI: 1215368204
Provider Name (Legal Business Name): SISTEMA UNIVERSITARIO ANA G MENDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 190 KM 1.8 SABANA ABAJO
CAROLINA PR
00984-2010
US

IV. Provider business mailing address

PO BOX 2010
CAROLINA PR
00984
US

V. Phone/Fax

Practice location:
  • Phone: 787-257-7373
  • Fax:
Mailing address:
  • Phone: 787-257-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANUEL AGOSTO
Title or Position: EXECUTIVE ADVISER
Credential: RT
Phone: 787-257-7373