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General NPI Number Information
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NPI Number | 1588988216
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Entity Type | Organization
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Legal Business Name | SAMBA BRAS MEDICAL, P.S.C
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | AVE. GENERAL VALERO 410 TORRE MEDICA SAN PABLO OFICINA 409
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-863-3636
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Fax | 787-863-3638
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Provider Business Mailing Address
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Address Line | P.O. BOX 823
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City | FAJARDO
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State | PR
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Zip | 00738-0823
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Country | US
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Telephone | 787-863-3636
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Fax | 787-863-3638
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. JAMIL ABOU EL HOSSEN DUARTE
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Credential | M.D
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Telephone | 787-863-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 11782
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License Number State | PR
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