Healthcare Provider Details

I. General information

NPI: 1184360174
Provider Name (Legal Business Name): SBDA CONSULTANTS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ST BO MANGO CALLE PAJUIL A5
JUNCOS PR
00777
US

IV. Provider business mailing address

PO BOX 1496
JUNCOS PR
00777-1496
US

V. Phone/Fax

Practice location:
  • Phone: 787-487-5706
  • Fax:
Mailing address:
  • Phone: 787-487-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANGEL TOMAS DAVILA
Title or Position: CEO
Credential:
Phone: 787-487-5706