Healthcare Provider Details

I. General information

NPI: 1124256813
Provider Name (Legal Business Name): INSTITUTO MEDICO DE CIALES, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CALLE JOSE DE DIEGO
CIALES PR
00638-3229
US

IV. Provider business mailing address

25 CALLE JOSE DE DIEGO
CIALES PR
00638-3229
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-1146
  • Fax: 787-871-1207
Mailing address:
  • Phone: 787-871-1146
  • Fax: 787-871-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number9227
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number9227
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number9227
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number9227
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number9227
License Number StatePR

VIII. Authorized Official

Name: DR. MARIA DE LOS ANGELES COLLAZO
Title or Position: PRESIDENT
Credential: M.D
Phone: 787-871-1146