Healthcare Provider Details

I. General information

NPI: 1467546572
Provider Name (Legal Business Name): GOBIERNO MUNICIPAL DE CIDRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SALIDA HOIA AGUAS BUENAS COMPLEJO DEPORTIUO
CIDRA PR
00739-0729
US

IV. Provider business mailing address

APARTADO 729
CIDRA PR
00739-0729
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-2375
  • Fax: 787-369-7990
Mailing address:
  • Phone: 787-739-2395
  • Fax: 787-369-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC-AMB-223
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. ADALBERTO REYES
Title or Position: DIRECTOR
Credential:
Phone: 787-434-1400