Healthcare Provider Details

I. General information

NPI: 1841697323
Provider Name (Legal Business Name): INSTITUTO DE MEDICINA DE FAMILIA DE MANATI CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E24 CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 723
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-5570
  • Fax: 787-862-3532
Mailing address:
  • Phone: 787-854-5570
  • Fax: 787-862-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number9027
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. CARLOS DELGADO REYES
Title or Position: PRESIDENT
Credential:
Phone: 787-854-5570