Healthcare Provider Details

I. General information

NPI: 1134511892
Provider Name (Legal Business Name): SOCIEDAD MEDICA PUERTO NUEVO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 F D ROOSEVELT PUERTO NUEVO
SAN JUAN PR
00920
US

IV. Provider business mailing address

1028 F D ROOSEVELT PUERTO NUEVO
SAN JUAN PR
00920
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-8316
  • Fax:
Mailing address:
  • Phone: 787-781-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HECTOR L PESQUERA
Title or Position: DIRECTOR
Credential:
Phone: 787-781-8316