MEDICARE: CENTROPOLIMENONITA DE COAMO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1376569434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTROPOLIMENONITA DE COAMO

Provider Business Mailing Address
First Line	:	13 CALLE MARIO BRASCHI
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-5835
Fax Number	:	787-803-1999

Provider Business Practice Location Address
First Line	:	13 CALLE MARIO BRASCHI
Second Line	:
City	:	COAMO
State	:	PR
Zip	:	00769-2501
Country	:	US
Telephone Number	:	787-825-5835
Fax Number	:	787-803-1999

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUIS ROBERTO CANAS
Credential	:	M.D.
Telephone Number	:	787-825-5835

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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Directions to “CENTROPOLIMENONITA DE COAMO ” Practice Location

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