Healthcare Provider Details

I. General information

NPI: 1104467489
Provider Name (Legal Business Name): CORPORACION DE SALUD MARIENA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 119 KM 53.7 BO FURNIAS
LAS MARIAS PR
00670
US

IV. Provider business mailing address

PO BOX 430
LAS MARIAS PR
00670-0430
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-4488
  • Fax:
Mailing address:
  • Phone: 787-827-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC MANUEL MAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-624-4750