Healthcare Provider Details

I. General information

NPI: 1285975813
Provider Name (Legal Business Name): MEDICAL OFFICE HEALTH SERVICES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO TERRANOVA CALLE MARGONAL DEL PARQUE CARR #2 KM 101.6
QUEBRADILLAS PR
00678-0903
US

IV. Provider business mailing address

PO BOX 903
QUEBRADILLAS PR
00678-0903
US

V. Phone/Fax

Practice location:
  • Phone: 787-895-0914
  • Fax: 787-895-6945
Mailing address:
  • Phone: 787-895-0914
  • Fax: 787-895-6945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number011789
License Number StatePR

VIII. Authorized Official

Name: MRS. MARIA DE LOS ANGELES LUGO
Title or Position: GENERAL MANAGER
Credential:
Phone: 787-415-7514