Provider Demographics
NPI:1295875169
Name:POLICLINICA BALDORIOTY
Entity type:Organization
Organization Name:POLICLINICA BALDORIOTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-568-8263
Mailing Address - Street 1:COND CASTILLO DEL MAR
Mailing Address - Street 2:SUITE 1358
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:482 CALLE FERNANDO CALDER
Practice Address - Street 2:URB ROOSVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2744
Practice Address - Country:US
Practice Address - Phone:787-568-8263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86269261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83811Medicare ID - Type Unspecified