Provider Demographics
NPI:1447339973
Name:SERVICIOS REUMATOLOGICOS DEL NORTE
Entity type:Organization
Organization Name:SERVICIOS REUMATOLOGICOS DEL NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-396-0737
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0667
Mailing Address - Country:US
Mailing Address - Phone:787-884-8686
Mailing Address - Fax:787-884-8686
Practice Address - Street 1:DOCTOR'S CENTER HOSPITAL ROAD#2 KM. 47.7
Practice Address - Street 2:TORRE MEDICA 1 SUITE#211
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-8686
Practice Address - Fax:787-884-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13110261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82116Medicare UPIN
PR20240Medicare ID - Type Unspecified