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General NPI Number Information
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NPI Number | 1306570551
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Entity Type | Organization
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Legal Business Name | INTERCAMBIOS PUERTO RICO, INC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 14 CALLE ANTONIO R BARCELO W
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City | FAJARDO
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State | PR
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Zip | 00738-5195
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Country | US
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Telephone | 787-908-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 165 CALLE DIEGO ZALDUONDO
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City | FAJARDO
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State | PR
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Zip | 00738-4729
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Country | US
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Telephone | 787-678-9008
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RAFAEL A TORRUELLA
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Credential |
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Telephone | 787-678-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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