Healthcare Provider Details

I. General information

NPI: 1679227003
Provider Name (Legal Business Name): TOA BAJA MEDICAL PLAZA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 KM 18.4 BO. CANDELARIA AREN
TOA BAJA PR
00951-0001
US

IV. Provider business mailing address

PMB 164 PO BOX 4002
VEGA ALTA PR
00692
US

V. Phone/Fax

Practice location:
  • Phone: 787-979-9189
  • Fax: 787-979-9168
Mailing address:
  • Phone: 787-306-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARLING T PANTOJA
Title or Position: PRESIDENT
Credential:
Phone: 787-306-1900