Healthcare Provider Details

I. General information

NPI: 1699946871
Provider Name (Legal Business Name): POLICLINICA LAS AMERICAS CENTER C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZOLETA LAS AMERICAS 2015 AVE LAS AMERICAS SUITE 101
PONCE PR
00717-0784
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: 787-842-8945
  • 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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR REYES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-842-8945