Healthcare Provider Details

I. General information

NPI: 1598090987
Provider Name (Legal Business Name): CORPORACION DE MEDICOS PRIMARIOS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BETANCES ST. #14
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

PO BOX 816
SANTA ISABEL PR
00757-0816
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-6455
  • Fax: 787-845-8014
Mailing address:
  • Phone: 787-845-6455
  • Fax: 787-845-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number11271
License Number StatePR

VIII. Authorized Official

Name: DR. DAVID D HEAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-845-6455