Healthcare Provider Details

I. General information

NPI: 1538487657
Provider Name (Legal Business Name): ALIANZA DE SALUD PARA TODO PUERTO RICO, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LUIS MUNOZ RIVERA 3
VEGA ALTA PR
00692
US

IV. Provider business mailing address

P.O. BOX 4317
VEGA BAJA PR
00694
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-0124
  • Fax: 787-883-0222
Mailing address:
  • Phone: 787-883-7645
  • Fax: 787-883-0222

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: DR. MILDALIAS DOMINGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-883-0124