Provider Demographics
NPI:1245656388
Name:SANUS CORP
Entity type:Organization
Organization Name:SANUS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:SOTO-GOITIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-378-6861
Mailing Address - Street 1:530 CALLE JUAN DAVILA
Mailing Address - Street 2:URB. LOS INGENIEROS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2750
Mailing Address - Country:US
Mailing Address - Phone:787-281-2255
Mailing Address - Fax:
Practice Address - Street 1:530 CALLE JUAN DAVILA
Practice Address - Street 2:URB. LOS INGENIEROS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2750
Practice Address - Country:US
Practice Address - Phone:787-281-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15567207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023217Medicare UPIN