Provider Demographics
NPI:1033538558
Name:SERVICIOS PROFESIONALES PRIVADO
Entity Type:Organization
Organization Name:SERVICIOS PROFESIONALES PRIVADO
Other - Org Name:SERVICIO DOMESTICOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENFERMERA GRADUADA RN BSN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OTERO PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN LIC 11519-A
Authorized Official - Phone:787-654-0346
Mailing Address - Street 1:HC 5 BOX 46128
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-654-0346
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 46128
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-9654
Practice Address - Country:US
Practice Address - Phone:787-654-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11519-A251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care