Healthcare Provider Details

I. General information

NPI: 1578849048
Provider Name (Legal Business Name): POLICLINICA LAS AMERICAS MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 BLVD LUIS A FERRE STE 101
PONCE PR
00717-0798
US

IV. Provider business mailing address

PMB 281 AVE MUNOZ RIVERA 1575
PONCE PR
00717-0211
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-8945
  • Fax: 787-290-4472
Mailing address:
  • Phone: 787-856-0844
  • Fax: 787-290-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR S REYES CABEZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-856-0844