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General NPI Number Information
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NPI Number | 1669234464
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Entity Type | Organization
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Legal Business Name | INNOVA MEDICAL CLINIC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | CARR 125 KM 18.1 BO. BAHOMAMEY
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 939-323-6472
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Fax |
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Provider Business Mailing Address
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Address Line | 41 URB VICTORIA CALLE TULIPAN
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | JOSE GABRIEL ARCE-DIAZ
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Credential | MD
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Telephone | 939-323-6472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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