Healthcare Provider Details

I. General information

NPI: 1669704219
Provider Name (Legal Business Name): SALA DE URGENCIAS SHALOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 101 6 TERRANOVA MARGINAL DEL PARQUE
QUEBRADILLAS PR
00678
US

IV. Provider business mailing address

PO BOX 903
QUEBRADILLAS PR
00678-0903
US

V. Phone/Fax

Practice location:
  • Phone: 787-895-0914
  • Fax: 787-895-4999
Mailing address:
  • Phone: 787-895-0914
  • Fax: 787-895-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number13
License Number StatePR

VIII. Authorized Official

Name: DR. ANIBAL PAGAN ROMERO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-895-0914