Provider Demographics
NPI:1003380247
Name:SERVICIOS DE SALUD DEL OESTE, LLC
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD DEL OESTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-692-5598
Mailing Address - Street 1:PO BOX 1562
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1562
Mailing Address - Country:US
Mailing Address - Phone:787-818-1405
Mailing Address - Fax:787-818-1401
Practice Address - Street 1:65 CALLE PEDRO SANTOS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4015
Practice Address - Country:US
Practice Address - Phone:787-818-1405
Practice Address - Fax:787-818-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management