Healthcare Provider Details

I. General information

NPI: 1265909626
Provider Name (Legal Business Name): IMHOTEP CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA SANTA ISABEL SUITE 15
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

BO SAN LUIS CALLE PALESTINA 81
AIBONITO PR
00705
US

V. Phone/Fax

Practice location:
  • Phone: 939-279-2092
  • Fax:
Mailing address:
  • Phone: 939-279-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS J. SANCHEZ
Title or Position: M.D.
Credential:
Phone: 939-279-2092