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General NPI Number Information
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NPI Number | 1104108927
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Entity Type | Organization
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Legal Business Name | SERVICIOS MEDICOS INTEGRADOS DE LAJAS CSP
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | CARR 116 KM 2.0
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City | LAJAS
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State | PR
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Zip | 00680-8116
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Country | US
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Telephone | 787-899-2865
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | LAJAS
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State | PR
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Zip | 00667-0902
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Country | US
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Telephone | 787-899-2865
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUBEN DARIO ROSARIO
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Credential | MD
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Telephone | 787-899-2865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 14435
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License Number State | PR
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