Provider Demographics
NPI:1770165326
Name:SERVICIOS MEDICOS DR. ANTONIO DECLET, INC
Entity type:Organization
Organization Name:SERVICIOS MEDICOS DR. ANTONIO DECLET, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DECLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-829-4476
Mailing Address - Street 1:20 CALLE RIUS RIVERA
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2337
Mailing Address - Country:US
Mailing Address - Phone:787-829-4476
Mailing Address - Fax:787-829-4946
Practice Address - Street 1:20 CALLE RIUS RIVERA
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2337
Practice Address - Country:US
Practice Address - Phone:787-829-4476
Practice Address - Fax:787-829-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service