Healthcare Provider Details

I. General information

NPI: 1508117441
Provider Name (Legal Business Name): CLINICA DE SALUD DEL ESTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/2 806 URB BRISAS DEL MAR
LUQUILLO PR
00773-0773
US

IV. Provider business mailing address

C/2 806 URB BRISAS DEL MAR
LUQUILLO PR
00773
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE CHAPMAN
Title or Position: PRESIDENT
Credential:
Phone: 787-889-4401