Healthcare Provider Details

I. General information

NPI: 1457560195
Provider Name (Legal Business Name): PROSALUDHMOCORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE DE DIEGO SAN JUAN HEALTHCENTR BLGG. SUITE 507
SAN JUAN PR
00907-2300
US

IV. Provider business mailing address

150 AVE DE DIEGO SAN JUAN HEALTHCENTR BLGG. SUITE 507
SAN JUAN PR
00907-2300
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-6565
  • Fax: 787-721-5028
Mailing address:
  • Phone: 787-724-6565
  • Fax: 787-721-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number146471
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS FRANCISCO HERNANDEZ
Title or Position: PRESIDENT
Credential: LCDO.
Phone: 787-724-6565