Provider Demographics
NPI:1588637789
Name:AGUADILLA MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:AGUADILLA MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHZAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-882-0303
Mailing Address - Street 1:PO BOX 250479
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0479
Mailing Address - Country:US
Mailing Address - Phone:787-882-0303
Mailing Address - Fax:787-997-1680
Practice Address - Street 1:2 AVE VICTORIA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4728
Practice Address - Country:US
Practice Address - Phone:787-882-0303
Practice Address - Fax:787-997-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22261Q00000X
PR1261QA1903X
261QE0002X
PR864291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4000404OtherEMERGENCY ROOM
PR5501113OtherANESTHESIA
PR73-314OtherEMERGENCY ROOM
PR3732-4OtherX RAY
PR6005853OtherLABORATORY
PR3732-2OtherEMERGENCY ROOM
PR3732-3OtherLABORATORY
PR5501121OtherGENERAL ANESTHESIA
PR0120073OtherMEDICAL SERVICES
PR030227OtherEMERGENCY ROOM
PR40001OtherMEDICAL SERVICES
PR3005054OtherX RAY
PR3732-5OtherPROCEDURES
PR56-324OtherX RAY
PR74-313OtherLABORATORY
PR3732-4OtherX RAY