Healthcare Provider Details

I. General information

NPI: 1033460720
Provider Name (Legal Business Name): HECTOR IVAN CARIDES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA ROSA C/ INGLATERRA 1355
ISABELA PR
00662-4764
US

IV. Provider business mailing address

URB. SANTA ROSA CALLE INGLATERRA 1355
ISABELA PR
00662-4764
US

V. Phone/Fax

Practice location:
  • Phone: 787-599-6630
  • Fax:
Mailing address:
  • Phone: 787-239-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number028594
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: