MEDICARE: ISLAND HEALTH CENTER CORP

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	163WW0000X	Wound Care Registered Nurse
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1629305313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND HEALTH CENTER CORP

Provider Business Mailing Address
First Line	:	PO BOX 16804
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-6804
Country	:	US
Telephone Number	:	787-306-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALLE MARGINAL # E7
Second Line	:	SANTA ROSA
City	:	BAYAMON
State	:	PR
Zip	:	00957-2536
Country	:	US
Telephone Number	:	787-786-8947
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARCILIO ALVARADO ROSAS III
Credential	:
Telephone Number	:	787-690-9018

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	05/11/2026

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