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General NPI Number Information
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NPI Number | 1154399673
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Entity Type | Organization
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Legal Business Name | INSTITUTO DE MEDICINA AVANZADA SUNNY HILLS CSP
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | B6 AVE SANTA JUANITA SUNNY HILLS
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City | BAYAMON
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State | PR
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Zip | 00956-5026
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Country | US
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Telephone | 787-269-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 88 CALLE ROBLE CIUDAD JARDIN III
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City | TOA ALTA
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State | PR
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Zip | 00953-4859
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Country | US
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Telephone | 787-269-2641
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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. CARLOS ALBERTO CORREA
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Credential | M.D.
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Telephone | 787-269-2641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10175
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License Number State | PR
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