Healthcare Provider Details

I. General information

NPI: 1649163858
Provider Name (Legal Business Name): SCARLETT MENJIVAR FLORENCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

52 CALLE MCKINLEY
MANATI PR
00674-5200
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax: 787-621-3710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number07140874
License Number StateLA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: