Provider Demographics
NPI:1124269709
Name:SALUTARIS DIALYSIS AND NEPHROLOGY CENTER CORPORATION
Entity type:Organization
Organization Name:SALUTARIS DIALYSIS AND NEPHROLOGY CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-653-0505
Mailing Address - Street 1:1479 AVE ASHFORD
Mailing Address - Street 2:APT 420
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1583
Mailing Address - Country:US
Mailing Address - Phone:787-653-0505
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172 HOSPITAL SAN JUAN BAUTISTA
Practice Address - Street 2:TERCER PISO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment