Provider Demographics
NPI:1053786137
Name:PR RENAL HEALTH AND RESEARCH
Entity type:Organization
Organization Name:PR RENAL HEALTH AND RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:NOELYS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:73868
Authorized Official - Phone:787-710-2532
Mailing Address - Street 1:69 CALLE NICOLAS SOTO RAMOS
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2714
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-986-7614
Practice Address - Street 1:69 CALLE NICOLAS SOTO RAMOS
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2714
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-986-7614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PR RENAL HEALTH AND RESEARCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73868251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care