Healthcare Provider Details

I. General information

NPI: 1447339973
Provider Name (Legal Business Name): SERVICIOS REUMATOLOGICOS DEL NORTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DOCTOR'S CENTER HOSPITAL ROAD#2 KM. 47.7 TORRE MEDICA 1 SUITE#211
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 667
DORADO PR
00646-0667
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-8686
  • Fax: 787-884-8686
Mailing address:
  • Phone: 787-884-8686
  • Fax: 787-884-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number13110
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. EFRAIN CARRASQUILLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-396-0737