=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881240984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST BEST HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2019
-----------------------------------------------------
Last Update Date | 08/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1540 CALLE BORI URB. BELISA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-6116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-788-4717
-----------------------------------------------------
Fax | 939-225-7474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70250 SUITE 144
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-8250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-8281
-----------------------------------------------------
Fax | 787-787-8782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | MIGUEL ANGEL SOSA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-313-8063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------