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General NPI Number Information
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NPI Number | 1558456616
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Entity Type | Organization
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Legal Business Name | CENTRO DE INVESTIGACION EDUCACION Y SERVICIOS MEDICOS PARA LA DIABETES
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | PRIMER PISO EDIF. DECANATO DE FARMACIA CENTRO MEDICO
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City | SAN JUAN
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State | PR
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Zip | 00936-8344
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Country | US
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Telephone | 787-773-8283
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Fax | 787-773-8303
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Provider Business Mailing Address
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Address Line | PMB #87 PO BOX 70344
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City | SAN JUAN
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State | PR
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Zip | 00936-8344
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Country | US
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Telephone | 787-773-8283
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Fax | 787-773-8303
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Authorized Official
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Title or Position | DIRECTOR
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Name | MIGUEL JOSE BUSTELO SANCLEMENTE
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Credential |
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Telephone | 787-753-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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