Healthcare Provider Details

I. General information

NPI: 1417916958
Provider Name (Legal Business Name): SAN BLAS HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21CALLE BALDORIOTY
COAMO PR
00769
US

IV. Provider business mailing address

PO BOX 1933
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-825-4140
  • Fax: 787-825-4140
Mailing address:
  • Phone: 787-825-4140
  • Fax: 787-825-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0691
License Number StatePR

VIII. Authorized Official

Name: MR. DAVID COLON SR.
Title or Position: OWNER ADMINISTRATOR
Credential: CPA OWNER
Phone: 787-825-4140