Healthcare Provider Details

I. General information

NPI: 1366465106
Provider Name (Legal Business Name): CENTRO INTEGRADO MEDICO DE AIBONITO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JULIO CINTRON 203 ALTOS
AIBONITO PR
00705
US

IV. Provider business mailing address

PO BOX 2010
CAGUAS PR
00726-2010
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-3222
  • Fax:
Mailing address:
  • Phone: 787-747-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DIEGO D VARGAS GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-747-0022