Healthcare Provider Details

I. General information

NPI: 1457548703
Provider Name (Legal Business Name): EASTERN ADVANCED HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CALLE DUFRESNE W
HUMACAO PR
00791-3609
US

IV. Provider business mailing address

59W CALLE DUFRESNE W
HUMACAO PR
00791-3609
US

V. Phone/Fax

Practice location:
  • Phone: 787-850-1858
  • Fax:
Mailing address:
  • Phone: 787-850-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. MELVIN RODRIGUEZ TORRES
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-850-1858