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Organization
ON SITE PREVENTIVE MEDICINE CSP
Active
Organization
ON SITE PREVENTIVE MEDICINE CSP
Active
Other names
ON SITE PREVENTIVE MEDICINE CSP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAXIMO C BLONDET MD (OWNER)
(787) 409-5869
Entity
Organization
Contact information
Practice address
400 AVE FD ROOSEVELT STE 409, SAN JUAN, PR 00918-2163
(787) 903-6100
(787) 273-0935
Mailing address
400 AVE FD ROOSEVELT STE 409, SAN JUAN, PR 00918-2163
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QP0905X
State or Local Public Health Clinic/Center
—
NULL
261QP2300X
Primary Care Clinic/Center
—
NULL
261QP2400X
Prison Health Clinic/Center
—
NULL
261QR1300X
Rural Health Clinic/Center
—
NULL
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
NULL
332900000X
Non-Pharmacy Dispensing Site
—
NULL
333300000X
Emergency Response System Companies
—
NULL
Other
Enumeration date
03/01/2021
Last updated
03/23/2021
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