Provider Demographics
NPI:1558468876
Name:SERV EMERG DEL NOROESTE
Entity Type:Organization
Organization Name:SERV EMERG DEL NOROESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SANJURJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-273-1227
Mailing Address - Street 1:APARTADO 592
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0592
Mailing Address - Country:US
Mailing Address - Phone:787-273-1227
Mailing Address - Fax:787-273-1849
Practice Address - Street 1:CALLE COLON # 106
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3166
Practice Address - Country:US
Practice Address - Phone:787-273-1227
Practice Address - Fax:787-273-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083573Medicare ID - Type Unspecified