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General NPI Number Information
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NPI Number | 1013402460
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Entity Type | Organization
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Legal Business Name | CLINICA DR. ABRAHAM
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1854 CALLE LOIZA
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City | SAN JUAN
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State | PR
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Zip | 00911-1824
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Country | US
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Telephone | 787-728-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 5859 ISLA VERDE CORAL BEACH TOWER 1 APT 1720
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City | CAROLINA
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State | PR
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Zip | 00979
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Country | US
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Telephone | 787-728-5476
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Fax | 787-963-1880
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Authorized Official
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Title or Position | OWNER
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Name | DR. MANUEL EDUARDO ABRAHAM
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Credential | MD
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Telephone | 787-728-5476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 18081
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License Number State | PR
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