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General NPI Number Information
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NPI Number | 1750675302
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Entity Type | Organization
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Legal Business Name | MECAAGUADA,INC
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 234 CALLE SAN NARCISO
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City | AGUADA
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State | PR
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Zip | 00602-3014
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Country | US
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Telephone | 787-546-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 112 URB MONTEMAR URB. MONTEMAR NO. 112
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City | AGUADA
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State | PR
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Zip | 00602-3034
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Country | US
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Telephone | 787-560-3350
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. NELSON E SANTIAGO
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Credential | MD
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Telephone | 787-546-8643
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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 | 11251
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License Number State | PR
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