Healthcare Provider Details

I. General information

NPI: 1174678460
Provider Name (Legal Business Name): DEPARTAMENTO DE SALUD OFICIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PUERTO RICO MEDICAL CENTER
RIO PIEDRAS PR
00919-1079
US

IV. Provider business mailing address

PO BOX 191079
SAN JUAN PR
00919-1079
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3232
  • Fax: 787-756-8907
Mailing address:
  • Phone: 787-474-0333
  • Fax: 787-756-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number40 CNC NUM 93-060
License Number StatePR

VIII. Authorized Official

Name: MR. VICTOR DIAZ GUZMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: MHSA
Phone: 787-474-0333