Provider Demographics
NPI:1710605597
Name:PANACEA SALUD LLC
Entity Type:Organization
Organization Name:PANACEA SALUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:BURGOS ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-221-7540
Mailing Address - Street 1:PO BOX 192082
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2082
Mailing Address - Country:US
Mailing Address - Phone:787-509-6877
Mailing Address - Fax:787-230-6681
Practice Address - Street 1:101 AVE SAN PATRICIO STE 1070
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3048
Practice Address - Country:US
Practice Address - Phone:787-509-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty