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136 Bda Caban Aguadilla PR 00603-9465 | |
| (787) 997-1111 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 136 Bda Caban, Aguadilla, Puerto Rico |
| Authorized Official Name and Position | Daritza Sanchez Santana (FACTURADORA) |
| Authorized Official Contact | 7873143431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
136 Bda Caban Aguadilla PR 00603-9465 Ph: (787) 997-1111 | 136 Bda Caban Aguadilla PR 00603-9465 Ph: (787) 997-1111 |
| NPI Number | 1225257710 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 08/25/2015 |
| Medicare PECOS PAC ID | 6608186564 |
|---|---|
| Medicare Enrollment ID | O20151104001530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225257710 | NPI | - | NPPES |
| 23314 | Other | PR | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 16009 (Puerto Rico) | Primary |
| Provider Name | Luis A Valle Pena |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1033186481 PECOS PAC ID: 4981639457 Enrollment ID: I20051004000248 |
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