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General NPI Number Information
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NPI Number | 1225469711
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Entity Type | Organization
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Legal Business Name | EQUUS CENTER OF PUERTO RICO INC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | CARR 941, KM 4.7 BARRIO JAGUAS
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City | GURABO
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-450-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 45 PLAZA LOS MOSAICOS HACIENDA SAN JOSE
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City | CAGUAS
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State | PR
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Zip | 00727
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Country | US
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Telephone | 787-450-1702
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDMUNDO JIMENEZ
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Credential | DR
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Telephone | 787-450-1702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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