Healthcare Provider Details

I. General information

NPI: 1174131437
Provider Name (Legal Business Name): CONCILIO DE SALUD INTEGRAL DE LOIZA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 188 # INT187
LOIZA PR
00772-1850
US

IV. Provider business mailing address

PO BOX 409
LOIZA PR
00772-0409
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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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