Provider Demographics
NPI:1912036286
Name:SERVICIOS DE SALUD DEL NORTE
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD DEL NORTE
Other - Org Name:GRP CDT VILLA LOS SANTOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-817-3144
Mailing Address - Street 1:PO BOX 9091
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-817-3144
Mailing Address - Fax:787-817-7284
Practice Address - Street 1:CALLE 16 V-1
Practice Address - Street 2:URBANZACION VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-1585
Practice Address - Fax:787-816-7284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICIOS DE SALUD DEL NORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 208D00000X
PR208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080121Medicare PIN