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General NPI Number Information
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NPI Number | 1962737387
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Entity Type | Organization
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Legal Business Name | PROVIDENCE DIAGNOSTIC AND MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/04/2009
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Last Update Date | 10/04/2009
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Provider Practice Location Address
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Address Line | 1400 CALLE SAN RAFAEL
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City | SAN JUAN
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State | PR
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Zip | 00909-2693
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Country | US
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Telephone | 787-522-5201
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Fax | 787-552-5207
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Provider Business Mailing Address
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Address Line | 1400 CALLE SAN RAFAEL
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City | SAN JUAN
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State | PR
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Zip | 00909-2693
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Country | US
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Telephone | 787-522-5201
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Fax | 787-552-5207
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAFAEL ASLANIAN
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Credential |
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Telephone | 787-522-5201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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