Provider Demographics
NPI:1215164579
Name:SIRIUS HEALTH PSC
Entity type:Organization
Organization Name:SIRIUS HEALTH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-565-8558
Mailing Address - Street 1:902 CALLE FLAMBOYAN
Mailing Address - Street 2:BOSQUE LLANO
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9984
Mailing Address - Country:US
Mailing Address - Phone:787-565-8558
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE AGUAS BUENAS
Practice Address - Street 2:BONEVILLE HEIGHTS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-4947
Practice Address - Country:US
Practice Address - Phone:787-565-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15385208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty