Healthcare Provider Details

I. General information

NPI: 1104950971
Provider Name (Legal Business Name): LARES MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 2.9 AVE. LOS PATRIOTAS
LARES PR
00669-1427
US

IV. Provider business mailing address

PO BOX 1427
LARES PR
00669-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-1444
  • Fax: 787-897-4952
Mailing address:
  • Phone: 787-897-1444
  • Fax: 787-897-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RIVERA MORALES EDGARD
Title or Position: MEDICO
Credential: M.D.
Phone: 787-897-1444