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General NPI Number Information
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NPI Number | 1154128544
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Entity Type | Organization
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Legal Business Name | WEST COAST PRIMARY CARE & PSYCHIATRY SERVICES LLC
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | AVENIDA AGUSTIN RAMOS CALER INT CARRETERA 112 KM 1.4, SUITE 9
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 939-366-3652
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CALLE GRUBBS
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City | AGUADILLA
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State | PR
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Zip | 00603-1502
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Country | US
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Telephone | 787-506-5259
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ISMAEL SANTIAGO
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Credential | MD
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Telephone | 787-506-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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