Healthcare Provider Details

I. General information

NPI: 1629472329
Provider Name (Legal Business Name): BARAHONA MEDICAL CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 155, KM 55.1 BO. BARAHONA
MOROVIS PR
00687
US

IV. Provider business mailing address

PO BOX 953
MOROVIS PR
00687-0953
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-5159
  • Fax:
Mailing address:
  • Phone: 787-862-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number007320
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number007320
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number007320
License Number StatePR

VIII. Authorized Official

Name: DR. MANUEL RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-862-4417