Healthcare Provider Details

I. General information

NPI: 1922050905
Provider Name (Legal Business Name): PUERTO RICO MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 AVE HOSTOS
SAN JUAN PR
00918-3226
US

IV. Provider business mailing address

515 AVE HOSTOS
SAN JUAN PR
00918-3232
US

V. Phone/Fax

Practice location:
  • Phone: 787-294-2158
  • Fax: 787-764-9445
Mailing address:
  • Phone: 787-294-2158
  • Fax: 787-764-9445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DELFINA ROSA DE LA CRUZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-294-2158