Provider Demographics
NPI:1578873055
Name:WATERFALL HEALTH SERVICE MANAGEMENT, CORP
Entity Type:Organization
Organization Name:WATERFALL HEALTH SERVICE MANAGEMENT, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-249-1521
Mailing Address - Street 1:PO BOX 10376
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922
Mailing Address - Country:US
Mailing Address - Phone:787-249-1521
Mailing Address - Fax:
Practice Address - Street 1:77 CHILE STREET
Practice Address - Street 2:URB FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922
Practice Address - Country:US
Practice Address - Phone:787-249-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty