Healthcare Provider Details

I. General information

NPI: 1184014540
Provider Name (Legal Business Name): CLINICA DE MEDICINA ESPECIALIZADA C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-140, KM. 57.4 BO. SAN AGUSTIN
FLORIDA PR
00650-0000
US

IV. Provider business mailing address

PO BOX 2360
MANATI PR
00674-2360
US

V. Phone/Fax

Practice location:
  • Phone: 939-440-0114
  • Fax: 787-680-7814
Mailing address:
  • Phone: 939-440-0114
  • Fax: 787-680-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBIN SANTIAGO-DELGADO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 939-440-0114