Provider Demographics
NPI:1437363215
Name:TOA BAJA HEALTH CENTER
Entity Type:Organization
Organization Name:TOA BAJA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-261-0202
Mailing Address - Street 1:PO BOX 2359
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-2359
Mailing Address - Country:US
Mailing Address - Phone:787-261-0202
Mailing Address - Fax:
Practice Address - Street 1:AVE SABANA SECA INT 867
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951
Practice Address - Country:US
Practice Address - Phone:787-261-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR66261QE0002X
SC66261QR0200X
PR800291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR19162Medicare ID - Type Unspecified