Healthcare Provider Details

I. General information

NPI: 1710208632
Provider Name (Legal Business Name): SERVICIOS DE SALUD SAN SEBASTIAN DEL PEPINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JOSE MENDEZ CARDONA #3
SAN SEBASTIAN PR
00685-0486
US

IV. Provider business mailing address

PO BOX 486
SAN SEBASTIAN PR
00685-0486
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax: 787-280-1698
Mailing address:
  • Phone: 787-896-1850
  • Fax: 787-280-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN FELICIANO
Title or Position: ASSOCIATE ADMINISTRATOR
Credential:
Phone: 787-896-1850