Provider Demographics
NPI:1508208653
Name:NSHAPE
Entity Type:Organization
Organization Name:NSHAPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-467-0606
Mailing Address - Street 1:559 CALLE ALVERIO
Mailing Address - Street 2:EXT ROOSEVELT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3725
Mailing Address - Country:US
Mailing Address - Phone:786-467-0606
Mailing Address - Fax:787-963-1344
Practice Address - Street 1:559 CALLE ALVERIO
Practice Address - Street 2:EXT ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3725
Practice Address - Country:US
Practice Address - Phone:786-467-0606
Practice Address - Fax:787-963-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16462261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center