Healthcare Provider Details

I. General information

NPI: 1265057863
Provider Name (Legal Business Name): WEST PCP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 113 KM 1.2 BO GUAYABO
ISABELA PR
00662
US

IV. Provider business mailing address

AVE. MILITAR 3623 PMB 492
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-1654
  • Fax: 787-830-1654
Mailing address:
  • Phone: 787-830-1654
  • Fax: 787-830-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SANTIAGO RIVERA ORTEGA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-830-1654