Healthcare Provider Details

I. General information

NPI: 1366697583
Provider Name (Legal Business Name): SAMARITAN HEALTH CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 181 KM 12 RAMAL 745 BO. ESPINO
SAN LORENZO PR
00754
US

IV. Provider business mailing address

BOX 505 PMB 183
SAN LORENZO PR
00754
US

V. Phone/Fax

Practice location:
  • Phone: 787-736-1600
  • Fax: 787-736-1600
Mailing address:
  • Phone: 787-736-1600
  • Fax: 787-736-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRIS R. DELGADO
Title or Position: PRESIDENT
Credential:
Phone: 787-736-1600