Healthcare Provider Details

I. General information

NPI: 1821458704
Provider Name (Legal Business Name): SICK BLOOD MED SERV CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO STE 603-604
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

369 CALLE DE DIEGO STE 603-604
SAN JUAN PR
00923-3003
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-6022
  • Fax: 787-753-6066
Mailing address:
  • Phone: 787-753-6022
  • Fax: 787-753-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17625
License Number StatePR

VIII. Authorized Official

Name: DR. PEDRO G SOLIVAN ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-771-7933