Healthcare Provider Details

I. General information

NPI: 1073638417
Provider Name (Legal Business Name): ASOCIANCION DE SERVICIOS MEDICOS PRIVADOS DE UTUADO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. FERNANDO L. GARCIA 114
UTUADO PR
00641
US

IV. Provider business mailing address

114 AVE. FERNANDO LUIS GARCIA
UTUADO PR
00641
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-6277
  • Fax: 787-894-6277
Mailing address:
  • Phone: 787-894-6277
  • Fax: 787-894-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE A CORTES
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 787-894-6277