Basic Information
| Provider Information | |||||||||
| NPI: | 1184629081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POLICLINICA DR SALVADOR RIBOT RUIZ INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7877610613 | ||||||||
| Practice Location | |||||||||
| Address1: | POLICLINICA DR RIBOT RUIZ INC | ||||||||
| Address2: | CARR. 857 KM 0.4 BARRIO CANOVANILLAS | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009860000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877763840 | ||||||||
| FaxNumber: | 7877610613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | RIBOT RUIZ | ||||||||
| AuthorizedOfficialFirstName: | SALVADOR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENTE-DIRECTOR MEDICO | ||||||||
| AuthorizedOfficialTelephone: | 7877763840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 0084672 | 05 | PR | MEDICAID |