Healthcare Provider Details

I. General information

NPI: 1255464293
Provider Name (Legal Business Name): DEPARTAMENTO DE SALUD OFICIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANTIGUO HOSPITAL DE DISTRITO HOSPITAL DR. JOSE' GANDARA, CARR. 14, SO MACHUELO
PONCE PR
00731
US

IV. Provider business mailing address

#100 URBANIZAUOR SANTA JUANITA AVENIDE LAUREL
BAYAMON PR
00956-4816
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-4731
  • Fax: 787-259-3998
Mailing address:
  • Phone: 872-594-7307
  • Fax: 787-259-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. CUIDUVEL DURAN
Title or Position: DIRECTOR EJECUTIVO
Credential: MD
Phone: 787-945-1472