Healthcare Provider Details

I. General information

NPI: 1962603670
Provider Name (Legal Business Name): TOA ALTA CURA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CALLE BARCELO
TOA ALTA PR
00953-2444
US

IV. Provider business mailing address

16 CALLE BARCELO
TOA ALTA PR
00953-2444
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-2270
  • Fax: 787-870-1529
Mailing address:
  • Phone: 787-870-2270
  • Fax: 787-870-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3170
License Number StatePR

VIII. Authorized Official

Name: MR. JERRY B BAEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-870-1529