=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255736351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPRESA MUNICIPAL SALUD INTEGRAL DE LA TIERRA ALTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2014
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 CALLE ROSANTA AULET
-----------------------------------------------------
City | JAYUYA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00664-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-828-0305
-----------------------------------------------------
Fax | 787-828-0901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 410
-----------------------------------------------------
City | JAYUYA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00664-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-828-0305
-----------------------------------------------------
Fax | 787-828-0901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GERENTE ADMINISTRATIVO
-----------------------------------------------------
Name | MRS. WANDA I ZAMORA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-828-0305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------