Healthcare Provider Details

I. General information

NPI: 1770703845
Provider Name (Legal Business Name): DEPARTAMENTO DE SALUD OFICIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 997 KM 0 HM 1 BO DESTINO
VIEQUES PR
00765
US

IV. Provider business mailing address

P O BOX 326
VIEQUES PR
00765
US

V. Phone/Fax

Practice location:
  • Phone: 787-741-0392
  • Fax: 787-741-0398
Mailing address:
  • Phone: 787-741-0392
  • Fax: 787-741-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number24
License Number StatePR

VIII. Authorized Official

Name: MRS. BETZAIDA MACKENZIE
Title or Position: DIRECTORA MEDICA
Credential: M.D.
Phone: 787-741-2165