Provider Demographics
NPI:1922348788
Name:SERVICIOS MEDICOS DEL VALLE DE LAJAS INC
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS DEL VALLE DE LAJAS INC
Other - Org Name:SERVICIOS MEDICOS DEL VALLE DE LAJAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-249-5097
Mailing Address - Street 1:PO BOX 1715
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1715
Mailing Address - Country:US
Mailing Address - Phone:787-899-4242
Mailing Address - Fax:787-899-8023
Practice Address - Street 1:237 AVE LOS VETERANOS
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2509
Practice Address - Country:US
Practice Address - Phone:787-899-4242
Practice Address - Fax:787-899-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR46261QE0002X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037717000Medicaid