Provider Demographics
NPI:1659720100
Name:SERVICIOS MEDICOS JUANA DIAZ- VILLALBA CRL
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS JUANA DIAZ- VILLALBA CRL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTERO SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-260-0447
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1422
Mailing Address - Country:US
Mailing Address - Phone:787-260-0447
Mailing Address - Fax:787-260-6147
Practice Address - Street 1:47 CALLE MUNOZ RIVERA ESQUINA SANTIAGO IGLESIAS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1422
Practice Address - Country:US
Practice Address - Phone:787-260-0447
Practice Address - Fax:787-260-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty