Healthcare Provider Details

I. General information

NPI: 1619074440
Provider Name (Legal Business Name): POLICLINICA DEL ATLANTICO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 111.3 BO MORA
ISABELA PR
00662
US

IV. Provider business mailing address

3623 AVE MILITAR PMB 226
ISABELA PR
00662-5802
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number6
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

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