Provider Demographics
NPI:1871617217
Name:SERVICIOS MEDICOS LAS MARIAS
Entity type:Organization
Organization Name:SERVICIOS MEDICOS LAS MARIAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VSPH
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-827-2230
Mailing Address - Street 1:PASEO ADRIAN ACEVEDO SANABRIA
Mailing Address - Street 2:CARR. 119 KM 27.4
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670
Mailing Address - Country:US
Mailing Address - Phone:787-827-2230
Mailing Address - Fax:787-827-4155
Practice Address - Street 1:PASEO ADRIAN ACEVEDO SANABRIA
Practice Address - Street 2:CARR. 119 KM 27.4
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670
Practice Address - Country:US
Practice Address - Phone:787-827-2230
Practice Address - Fax:787-827-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F1610333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4021591OtherNABP