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General NPI Number Information
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NPI Number | 1093963514
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Entity Type | Organization
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Legal Business Name | POLICLINICA DEL CARMEN
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | MUNOZ RIVERA #208
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City | PENUELAS
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State | PR
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Zip | 00624
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Country | US
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Telephone | 787-836-0419
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Fax | 787-836-0419
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | PENUELAS
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State | PR
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Zip | 00624
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Country | US
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Telephone | 787-836-0419
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Fax | 787-836-0419
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. ILEANA ECHEVARRIA
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Credential | MD
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Telephone | 787-836-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 15413
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License Number State | PR
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