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General NPI Number Information
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NPI Number | 1659720100
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Entity Type | Organization
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Legal Business Name | SERVICIOS MEDICOS JUANA DIAZ- VILLALBA CRL
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 47 CALLE MUNOZ RIVERA ESQUINA SANTIAGO IGLESIAS
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City | JUANA DIAZ
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State | PR
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Zip | 00795-1422
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Country | US
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Telephone | 787-260-0447
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Fax | 787-260-6147
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Provider Business Mailing Address
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Address Line | PO BOX 1422
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City | JUANA DIAZ
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State | PR
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Zip | 00795-1422
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Country | US
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Telephone | 787-260-0447
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Fax | 787-260-6147
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RICARDO J MONTERO SANTIAGO
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Credential |
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Telephone | 787-260-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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