Healthcare Provider Details

I. General information

NPI: 1558589788
Provider Name (Legal Business Name): EMERGENCY DEPARTMENT MEDICAL SERVICES, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 AVE ASHFORD
SAN JUAN PR
00907-1511
US

IV. Provider business mailing address

ESTANCIAS DE SAN FERNANDO STREET #4 B-17
CAROLINA PR
00985-5213
US

V. Phone/Fax

Practice location:
  • Phone: 787-725-5613
  • Fax: 787-725-5613
Mailing address:
  • Phone: 787-721-2160
  • Fax: 787-722-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS R ALVAREZ
Title or Position: PRESIDENT
Credential: MD MHSA
Phone: 787-721-2160