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General NPI Number Information
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NPI Number | 1699118562
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Entity Type | Organization
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Legal Business Name | PRO SALUD CARE PSC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 99 CALLE CORCHADO JUARBE
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City | ISABELA
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State | PR
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Zip | 00662
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Country | US
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Telephone | 787-609-6573
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Fax | 787-609-6574
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Provider Business Mailing Address
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Address Line | PO BOX 886
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City | ISABELA
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State | PR
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Zip | 00662-0886
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Country | US
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Telephone | 787-609-6573
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Fax | 787-609-6574
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ABIGAIL LOPEZ DE LASALLE
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Credential | M.D.
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Telephone | 787-609-6573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 15434
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License Number State | PR
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