Healthcare Provider Details

I. General information

NPI: 1225387699
Provider Name (Legal Business Name): INFUSION SOLUTIONS OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CARR 2 STE 301
GUAYNABO PR
00966-1830
US

IV. Provider business mailing address

108 CARR 2 STE 301
GUAYNABO PR
00966-1830
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-7200
  • Fax: 787-779-1430
Mailing address:
  • Phone: 787-780-7200
  • Fax: 787-779-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK MONTGOMERY
Title or Position: CEO
Credential:
Phone: 888-315-3395