Provider Demographics
NPI:1053158857
Name:DEPARTAMENTO DE SALUD OFICIAL
Entity type:Organization
Organization Name:DEPARTAMENTO DE SALUD OFICIAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARIO AUXILIAR
Authorized Official - Prefix:MR
Authorized Official - First Name:YESAREL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PESANTE SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-2929
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:VIEQUES
Mailing Address - State:PR
Mailing Address - Zip Code:00765
Mailing Address - Country:US
Mailing Address - Phone:787-765-2929
Mailing Address - Fax:
Practice Address - Street 1:URB BRISAS LAS MARIAS
Practice Address - Street 2:CALLE GEMINIS #206
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTAMENTO DE SALUD OFICIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038817500Medicaid