Healthcare Provider Details

I. General information

NPI: 1528642246
Provider Name (Legal Business Name): NANCY ALICEA MD,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 05/09/2021
Certification Date: 05/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FRANKLIN D ROOSEVELT
SAN JUAN PR
00918-2103
US

IV. Provider business mailing address

400 AVE FRANKLIN D ROOSEVELT
SAN JUAN PR
00918-2103
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-0527
  • Fax: 787-764-7963
Mailing address:
  • Phone: 787-274-0527
  • Fax: 787-764-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY ALICEA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-274-0527