Provider Demographics
NPI:1003124405
Name:POLICLINICA DR. JOSE MORA DELGADO, INC.
Entity Type:Organization
Organization Name:POLICLINICA DR. JOSE MORA DELGADO, INC.
Other - Org Name:POLICLINICA DR. MORA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-872-7095
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0526
Mailing Address - Country:US
Mailing Address - Phone:787-872-6815
Mailing Address - Fax:787-872-7095
Practice Address - Street 1:7342 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3466
Practice Address - Country:US
Practice Address - Phone:787-872-6815
Practice Address - Fax:787-872-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care