# POLICLINICA FAMILIAR SHALOM INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831302173
- **Authorized official:** MR. IVAN FELICIANO (SUPERVISOR)
- **Authorized official phone:** (787) 291-0991

## Contact information

- **Practice address:** BO TERRANOVA CALLE MARGINAL DEL PARQUE, QUEBRADILLAS, PR 00678
- **Practice address phone:** (787) 895-0914
- **Mailing address:** PO BOX 903, QUEBRADILLAS, PR 00678-0903
- **Mailing address phone:** (787) 895-0914

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | 145 | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | 145 | — | Yes |
| 208D00000X | General Practice Physician | 11789 | PR | — |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 07/06/2017