Healthcare Provider Details

I. General information

NPI: 1982067575
Provider Name (Legal Business Name): COSTA SALUD COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CALLE COLON
AGUADA PR
00602-3002
US

IV. Provider business mailing address

PO BOX 638
RINCON PR
00677-0638
US

V. Phone/Fax

Practice location:
  • Phone: 787-252-5500
  • Fax:
Mailing address:
  • Phone: 787-823-5500
  • Fax: 787-252-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number17F3333
License Number StatePR

VIII. Authorized Official

Name: SUSANA PEREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-823-0440