Healthcare Provider Details

I. General information

NPI: 1629931738
Provider Name (Legal Business Name): TELESALUD BORICUA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 AVE PONCE DE LEON
SAN JUAN PR
00909-5001
US

IV. Provider business mailing address

1511 AVE PONCE DE LEON
SAN JUAN PR
00909-5001
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-1075
  • Fax:
Mailing address:
  • Phone: 787-645-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS ENRIQUE ROMAN SANCHEZ
Title or Position: PRESIDENT
Credential: MD MHSA
Phone: 787-645-1075