Provider Demographics
NPI:1316548845
Name:PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
Entity Type:Organization
Organization Name:PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-523-5767
Mailing Address - Street 1:PO BOX 195615
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5615
Mailing Address - Country:US
Mailing Address - Phone:787-523-5767
Mailing Address - Fax:
Practice Address - Street 1:140 AVE. LAS CUMBRES CARR 199 GUAYNABO MEDICAL MALL
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-523-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health