Healthcare Provider Details

I. General information

NPI: 1154382075
Provider Name (Legal Business Name): SAN BLAS HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE CELIS AGUILERA
SANTA ISABEL PR
00757-2623
US

IV. Provider business mailing address

PO BOX 1933
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-7675
  • Fax: 787-845-7675
Mailing address:
  • Phone: 787-845-7675
  • Fax: 787-745-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number937
License Number StatePR

VIII. Authorized Official

Name: MR. DAVID COLON SR.
Title or Position: OWNER ADMINISTRATOR
Credential: CPA OWNER
Phone: 787-825-4140