Healthcare Provider Details

I. General information

NPI: 1962949040
Provider Name (Legal Business Name): CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SARGENTO GERARDO SANTIAGO CARRETERA 14 INTERIOR
AIBONITO PR
00705-1379
US

IV. Provider business mailing address

PO BOX 372800
CAYEY PR
00737-2800
US

V. Phone/Fax

Practice location:
  • Phone: 787-434-1700
  • Fax: 787-434-1714
Mailing address:
  • Phone: 787-434-1700
  • Fax: 787-434-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LUIS F RODRIGUEZ RAMOS
Title or Position: COORDINADOR FACTURACION Y COBRO CIM
Credential:
Phone: 787-434-1700