Healthcare Provider Details

I. General information

NPI: 1609852318
Provider Name (Legal Business Name): JUAN BALASQUIDES DE LOS SANTOS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C/JAIME ACOSTA VELARDE # 3
VEGA ALTA PR
00692-0351
US

IV. Provider business mailing address

PO BOX 351
VEGA ALTA PR
00692-0351
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-4462
  • Fax: 787-270-4941
Mailing address:
  • Phone: 787-883-4462
  • Fax: 787-270-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: