Provider Demographics
NPI:1255675377
Name:CLINICA DE SALUD Y PREVENCION DE ANASCO
Entity Type:Organization
Organization Name:CLINICA DE SALUD Y PREVENCION DE ANASCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-432-3837
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0171
Mailing Address - Country:US
Mailing Address - Phone:469-432-3837
Mailing Address - Fax:
Practice Address - Street 1:14 ESQUINA IBANEZ
Practice Address - Street 2:CALLE SAN ANTONIO
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0014
Practice Address - Country:US
Practice Address - Phone:469-432-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR503111N00000X
PR401111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty