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General NPI Number Information
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NPI Number | 1295875169
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Entity Type | Organization
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Legal Business Name | POLICLINICA BALDORIOTY
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 482 CALLE FERNANDO CALDER URB ROOSVELT
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City | SAN JUAN
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State | PR
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Zip | 00918-2744
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Country | US
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Telephone | 787-568-8263
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Fax |
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Provider Business Mailing Address
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Address Line | COND CASTILLO DEL MAR SUITE 1358
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City | CAROLINA
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State | PR
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Zip | 00979-5300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAFAEL MARCHENA
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Credential |
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Telephone | 787-568-8263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 86269
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License Number State | PR
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