Healthcare Provider Details

I. General information

NPI: 1720058753
Provider Name (Legal Business Name): INNOVACION EN SALUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO: MARIN 95 CALLE 5
GUAYAMA PR
00784-0000
US

IV. Provider business mailing address

BO: MARIN 95 CALLE 5
GUAYAMA PR
00784-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-557-7264
  • Fax:
Mailing address:
  • Phone: 787-557-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number07014
License Number StatePR

VIII. Authorized Official

Name: MISS WANDA SOCORRO BETANCOURT
Title or Position: DIRECTOR OF NURSING
Credential: RN.BSN
Phone: 787-557-7264