Healthcare Provider Details

I. General information

NPI: 1033418496
Provider Name (Legal Business Name): NUEVA VIDA DE LA SALUD II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 CALLE ITALIA
SAN JUAN PR
00917-3625
US

IV. Provider business mailing address

PO BOX 468
VEGA BAJA PR
00694-0468
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-2686
  • Fax: 787-270-5292
Mailing address:
  • Phone: 787-270-2686
  • Fax: 787-270-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE C PRADO
Title or Position: PRESIDENTE
Credential:
Phone: 787-270-2686