Provider Demographics
NPI:1760638555
Name:POLICLINICA DEL ATLANTICO
Entity Type:Organization
Organization Name:POLICLINICA DEL ATLANTICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRALD
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:787-830-7737
Mailing Address - Street 1:PMB 226
Mailing Address - Street 2:PO BOX 80,000
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-830-7737
Mailing Address - Fax:787-830-7839
Practice Address - Street 1:CARR. #2 K.M. 111.2
Practice Address - Street 2:BO. MORA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-7737
Practice Address - Fax:787-830-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1149261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1149Medicaid