=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215719711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERNEW MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2023
-----------------------------------------------------
Last Update Date | 10/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 891 CALLE 49 SE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00921-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-232-0007
-----------------------------------------------------
Fax | 850-353-7180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2-2 PARKVILLE CT
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-4751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-342-7504
-----------------------------------------------------
Fax | 850-353-7180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DARLIN CELESTE DIAZ-GOMEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-342-7504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------