Healthcare Provider Details

I. General information

NPI: 1003261835
Provider Name (Legal Business Name): ISLA MEDICAL SERVICES CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE MATADERO SUR
GURABO PR
00778
US

IV. Provider business mailing address

PO BOX 7589
CAGUAS PR
00726-7589
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-5353
  • Fax: 787-653-5364
Mailing address:
  • Phone: 787-653-5353
  • Fax: 787-653-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO BEAUCHAMP
Title or Position: PRESIDENT
Credential: MD
Phone: 787-653-5353