Healthcare Provider Details

I. General information

NPI: 1710986393
Provider Name (Legal Business Name): SERVICIOS MEDICOS LAS MARIAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO ADRIAN ACEVEDO SANABRIA CARR. 119, KM27.4
LAS MARIAS PR
00670-0023
US

IV. Provider business mailing address

PO BOX 23
LAS MARIAS PR
00670-0023
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-2230
  • Fax: 787-827-4155
Mailing address:
  • Phone: 787-827-2230
  • Fax: 787-827-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MR. ROBERTO PEREZ PADIN
Title or Position: DIRECTOR EJECUTIVO
Credential:
Phone: 787-827-2230