Healthcare Provider Details

I. General information

NPI: 1992773980
Provider Name (Legal Business Name): SERVICIOS MEDICOS DE HORMIGUEROS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LUIS MUNOZ MARTIN 2
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

PO BOX 1520
HORMIGUEROS PR
00660-1520
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-0111
  • Fax: 787-849-0707
Mailing address:
  • Phone: 787-849-0111
  • Fax: 787-849-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number44
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number44
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number740
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number44
License Number StatePR

VIII. Authorized Official

Name: JOSE M ROVIRA
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-849-0111