Healthcare Provider Details

I. General information

NPI: 1396758686
Provider Name (Legal Business Name): CONCILIO DE SALUD INTEGRAL DE LOIZA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 188 # INT187
LOIZA PR
00772-1850
US

IV. Provider business mailing address

PO BOX 509
LOIZA PR
00772-0509
US

V. Phone/Fax

Practice location:
  • Phone: 787-876-2042
  • Fax: 787-876-1120
Mailing address:
  • Phone: 787-876-2042
  • Fax: 787-876-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number15F1765
License Number StatePR

VIII. Authorized Official

Name: IRMA ALVAREZ
Title or Position: PHARMACIST
Credential:
Phone: 787-876-2042