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General NPI Number Information
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NPI Number | 1861167124
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Entity Type | Organization
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Legal Business Name | CLINICA SANAMED LLC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | CROWN HILL CALLE CARITE 125 ESQUINA AVE. PARANA, LOCAL #2
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 939-945-8458
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Fax |
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Provider Business Mailing Address
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Address Line | 562 SUMMIT HILLS CALLE GREENWOOD
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City | SAN JUAN
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State | PR
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Zip | 00920-4322
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Country | US
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Telephone | 939-945-8458
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Fax |
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Authorized Official
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Title or Position | PERSONA AUTORIZADA
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Name | JORGE MONTALVO
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Credential | MD
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Telephone | 787-674-4124
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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