Provider Demographics
NPI:1285648022
Name:POLICLINICA SAN PEDRO PSC
Entity Type:Organization
Organization Name:POLICLINICA SAN PEDRO PSC
Other - Org Name:CDT POLICLINICA SAN PEDRO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-839-3980
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0818
Mailing Address - Country:US
Mailing Address - Phone:787-839-3980
Mailing Address - Fax:787-271-2515
Practice Address - Street 1:211 CALLE MORSE
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2350
Practice Address - Country:US
Practice Address - Phone:787-839-3980
Practice Address - Fax:787-271-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1059291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004001478OtherACAA
PR6603483331OtherMCS
PR31320OtherTRIPLE-S
PR660348333OtherAMERICAN HEALTH
PR660348333OtherMAPHRE
PR9964OtherIMC
PR3739-3-5068OtherPROSAM
PR660348333OtherCIGNA
PRM215OtherMENONITA
PR660348333OtherAETNA
PR1400123966OtherGLOBAL
PR660348333OtherCOSVI
PR7140014OtherHUMANA
PR660348333OtherGHI
PR660348333OtherPALIC
PR1400123966OtherGLOBAL
PR660348333OtherPALIC