Healthcare Provider Details

I. General information

NPI: 1427435536
Provider Name (Legal Business Name): EMERGENCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 867 KM 2.2 AVE. SABANA SECA
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 1103
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-3330
  • Fax: 787-875-4904
Mailing address:
  • Phone: 787-380-1122
  • Fax: 787-875-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number048073
License Number StatePR

VIII. Authorized Official

Name: MR. JUAN C HEREDIA
Title or Position: CHIEF OPERATOR
Credential: BSPH
Phone: 787-380-1122