Healthcare Provider Details

I. General information

NPI: 1447670682
Provider Name (Legal Business Name): AJC SURGICAL HEALTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC PROFESSIONAL PLAZA SUITE 201
MANATI PR
00674
US

IV. Provider business mailing address

1420 CALLE MARBELLA MANSIONES VISTAMAR MARINA
CAROLINA PR
00983-1591
US

V. Phone/Fax

Practice location:
  • Phone: 787-921-2777
  • Fax:
Mailing address:
  • Phone: 787-587-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15946
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ARMANDO JAVIER CRUZADO
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 787-587-3731