Healthcare Provider Details

I. General information

NPI: 1093851008
Provider Name (Legal Business Name): CORPORACION PROFESIONAL DE SERVICIOS DE SALUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A13 CALLE VENDIG URB. SAN SALVADOR
MANATI PR
00674-5396
US

IV. Provider business mailing address

A13 CALLE VENDIG URB. SAN SALVADOR
MANATI PR
00674-5396
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-6161
  • Fax: 787-884-6966
Mailing address:
  • Phone: 787-884-6161
  • Fax: 787-884-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice 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: DR. WALTER RIVERA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 787-884-6161