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General NPI Number Information
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NPI Number | 1881889947
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Entity Type | Organization
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Legal Business Name | OCEANSIDE MEDICAL SERVICES CORP
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | EDIFICIO PLAZA DEL MAR CARR 459 KM 11.4
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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 | 787-830-5914
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Fax | 787-877-2145
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Provider Business Mailing Address
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Address Line | 3107 CALLE BERMUDA UBR ISLAZUL
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City | ISABELA
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State | PR
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Zip | 00662-6354
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Country | US
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Telephone | 787-830-5914
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Fax | 787-877-2145
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Authorized Official
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Title or Position | DUENO
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Name | DR. IBELITH MIRANDA
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Credential |
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Telephone | 787-830-5914
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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 | 16169
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License Number State | PR
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