Healthcare Provider Details

I. General information

NPI: 1902272172
Provider Name (Legal Business Name): SERVICIOS PREVENTIVOS DE SALUD DE PUERTO RICO, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE JOSE MENDEZ CARDONA
SAN SEBASTIAN PR
00685
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 Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. VIVIAN FELICIANO-NIEVES
Title or Position: DIRECTORA EJECUTIVA
Credential:
Phone: 787-896-1850