Healthcare Provider Details

I. General information

NPI: 1669725743
Provider Name (Legal Business Name): INSTITUTO DE NEFROLOGIA E HIPERTENSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE PAVIA STE 214 PAVIA MEDICAL PLAZA
SAN JUAN PR
00909-2244
US

IV. Provider business mailing address

PO BOX 19405
SAN JUAN PR
00910-1405
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-7008
  • Fax:
Mailing address:
  • Phone: 787-726-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6160
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS J QUESADA
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 787-726-7008