Provider Demographics
NPI:1700107513
Name:CLINICA MUNDO SALUD SAN SEBASTIAN C.S.P.
Entity Type:Organization
Organization Name:CLINICA MUNDO SALUD SAN SEBASTIAN C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:PEREZ FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-280-2626
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0397
Mailing Address - Country:US
Mailing Address - Phone:787-280-2626
Mailing Address - Fax:
Practice Address - Street 1:594 AVE EMERITO ESTRADA RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3114
Practice Address - Country:US
Practice Address - Phone:787-280-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17408208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty