Provider Demographics
NPI:1134511892
Name:SOCIEDAD MEDICA PUERTO NUEVO
Entity type:Organization
Organization Name:SOCIEDAD MEDICA PUERTO NUEVO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PESQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-781-8316
Mailing Address - Street 1:1028 F D ROOSEVELT
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-781-8316
Mailing Address - Fax:
Practice Address - Street 1:1028 F D ROOSEVELT
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-781-8316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service