Healthcare Provider Details

I. General information

NPI: 1033777180
Provider Name (Legal Business Name): PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 AVE LAS CUMBRES
GUAYNABO PR
00969-5523
US

IV. Provider business mailing address

PO BOX 195615
SAN JUAN PR
00919-5615
US

V. Phone/Fax

Practice location:
  • Phone: 787-789-2101
  • Fax: 800-920-7754
Mailing address:
  • Phone: 787-523-5767
  • Fax: 800-920-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NARDY DELGADO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 787-523-5767