Healthcare Provider Details

I. General information

NPI: 1538266952
Provider Name (Legal Business Name): PROGRAMA MEDICO DEL NORTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FERNANDO VELAZQUEZ ESQUINA FRANKLIN D ROOSEVELT #70
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 143114
ARECIBO PR
00614-3114
US

V. Phone/Fax

Practice location:
  • Phone: 787-820-9181
  • Fax: 787-820-9181
Mailing address:
  • Phone: 787-820-9181
  • Fax: 787-820-9181

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 Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number2185
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. GLORIA A DELGADO
Title or Position: GENERALIST MD
Credential:
Phone: 787-462-2375