Healthcare Provider Details

I. General information

NPI: 1760638555
Provider Name (Legal Business Name): POLICLINICA DEL ATLANTICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. #2 K.M. 111.2 BO. MORA
ISABELA PR
00662
US

IV. Provider business mailing address

PMB 226 PO BOX 80,000
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-7737
  • Fax: 787-830-7839
Mailing address:
  • Phone: 787-830-7737
  • Fax: 787-830-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1149
License Number StatePR

VIII. Authorized Official

Name: DR. ADRIAN GIRALD IV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-830-7737