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General NPI Number Information
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NPI Number | 1669635397
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Entity Type | Organization
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Legal Business Name | NORTHEAST CORP
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | AVE 1 SANTA RITA SUITE 304
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City | VEGA ALTA
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State | PR
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Zip | 00692-0000
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Country | US
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Telephone | 787-270-1345
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Fax | 787-270-1350
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Provider Business Mailing Address
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Address Line | AVE 1 URB SANTA RITA OFFICE 304
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City | VEGA ALTA
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State | PR
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Zip | 00692-0000
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Country | US
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Telephone | 787-270-1345
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Fax | 787-270-1350
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JOSE SERRANO
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Credential | LIC
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Telephone | 787-594-6383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 31
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License Number State | PR
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