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General NPI Number Information
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NPI Number | 1720058753
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Entity Type | Organization
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Legal Business Name | INNOVACION EN SALUD
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | BO: MARIN 95 CALLE 5
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City | GUAYAMA
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State | PR
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Zip | 00784-0000
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Country | US
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Telephone | 787-557-7264
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Fax |
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Provider Business Mailing Address
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Address Line | BO: MARIN 95 CALLE 5
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City | GUAYAMA
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State | PR
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Zip | 00784-0000
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Country | US
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Telephone | 787-557-7264
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MISS WANDA SOCORRO BETANCOURT
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Credential | RN.BSN
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Telephone | 787-557-7264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 07014
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License Number State | PR
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