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General NPI Number Information
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NPI Number | 1265723977
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Entity Type | Organization
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Legal Business Name | TEMPLO SAGRADO DE INICIACION RESURRECION Y ASCENCION INC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 40 TEODOMIRO DELFAUS ST
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City | JUNCOS
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State | PR
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Zip | 00777
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Country | US
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Telephone | 510-606-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 40 TEODOMIRO DELFAUS ST
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City | JUNCOS
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State | PR
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Zip | 00777
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Country | US
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Telephone | 510-606-7615
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Fax |
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Authorized Official
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Title or Position | HIGH PRIEST
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Name | DR. FEDERICO DELGADO
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Credential | PHD
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Telephone | 510-606-7516
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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 | 47784
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License Number State | PR
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