Provider Demographics
NPI:1194797498
Name:SERVICIO SALUD DEL NORTE
Entity type:Organization
Organization Name:SERVICIO SALUD DEL NORTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA J.
Authorized Official - Middle Name:GONZALEZ
Authorized Official - Last Name:AGRASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-817-3144
Mailing Address - Street 1:PO BOX 9091
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9091
Mailing Address - Country:US
Mailing Address - Phone:787-817-3144
Mailing Address - Fax:787-879-4315
Practice Address - Street 1:URB. VILLA LOS SANTOS
Practice Address - Street 2:CALLE 16 V-1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-3144
Practice Address - Fax:787-879-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTAX I.D.