MEDICARE: HAZ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1619792033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZ LLC

Provider Business Mailing Address
First Line	:	CAMINO DEL MAR
Second Line	:	8034 PLAZA CARIBE
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4380
Country	:	US
Telephone Number	:	787-425-7803
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 CARR 696
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-5718
Country	:	US
Telephone Number	:	787-625-5050
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY QUILES-SANTANA
Credential	:	MD
Telephone Number	:	787-425-7803

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “HAZ LLC ” Practice Location

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