Healthcare Provider Details

I. General information

NPI: 1073808176
Provider Name (Legal Business Name): CONCILIO DE SALUD INTEGRAL DE LOIZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #188 INT #187
LOIZA PR
00772
US

IV. Provider business mailing address

PO BOX 509
LOIZA PR
00772-0509
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2042
  • Fax: 787-256-1900
Mailing address:
  • Phone: 787-876-2042
  • Fax: 787-256-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19
License Number StatePR

VIII. Authorized Official

Name: CESAR A RODRIGUEZ ROMAN
Title or Position: DIRECTOR EJECUTIVO
Credential: MHSA
Phone: 787-876-2042