Healthcare Provider Details

I. General information

NPI: 1396215885
Provider Name (Legal Business Name): ENDOCRINOLOGY INNOVATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL MANATI MEDICAL CENTER URB ATENAS CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

HC 8 BOX 84612
SAN SEBASTIAN PR
00685-8726
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone: 787-245-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHEILA S MERCADO MENDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-245-6859