Provider Demographics
NPI:1912027954
Name:SL CONSULT MEDICAL PR
Entity Type:Organization
Organization Name:SL CONSULT MEDICAL PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-217-5205
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:PMB 291
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-1283
Mailing Address - Country:US
Mailing Address - Phone:787-217-5205
Mailing Address - Fax:787-715-0585
Practice Address - Street 1:CARR 183 KM 6.8 BO HATO
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9781
Practice Address - Country:US
Practice Address - Phone:787-217-5205
Practice Address - Fax:787-715-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4173720341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance