Organization
NORTHEAST CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOSE SERRANO LIC (ADMINISTRATOR)
(787) 594-6383
Entity
Organization
Contact information
Practice address
AVE 1 SANTA RITA, SUITE 304, VEGA ALTA, PR 00692-0000
(787) 270-1345
(787) 270-1350
Mailing address
AVE 1 URB SANTA RITA, OFFICE 304, VEGA ALTA, PR 00692-0000
(787) 270-1345
(787) 270-1350
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
31
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31
HEALTH LICENCE
PR
Enumeration date
07/02/2008
Last updated
08/26/2008
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