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General NPI Number Information
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NPI Number | 1477580496
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Entity Type | Organization
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Legal Business Name | LARES MEDICAL CENTER INC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | CARR 111 KM 2.9 AVE LOS PATRIOTAS
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City | LARES
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State | PR
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Zip | 00669-1427
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Country | US
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Telephone | 787-897-1444
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Fax | 787-897-4952
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Provider Business Mailing Address
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Address Line | PO BOX 1427
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City | LARES
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State | PR
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Zip | 00669-1427
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Country | US
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Telephone | 787-897-1444
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Fax | 787-897-4952
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Authorized Official
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Title or Position | MEDICO
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Name | DR. RODRIGUEZ CRUZ BALTAZAR
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Credential | M.D.
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Telephone | 787-897-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 119
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License Number State | PR
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