Healthcare Provider Details

I. General information

NPI: 1215081492
Provider Name (Legal Business Name): CENTRO MEDICO DEL TURABO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#70 SANTA CRUZ STREET URB SANTA CRUZ
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 4980
CAGUAS PR
00726-4980
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-2224
  • Fax: 787-653-2217
Mailing address:
  • Phone: 787-620-4320
  • Fax: 787-620-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15024
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15091
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13653
License Number StatePR

VIII. Authorized Official

Name: MR. ORLANDO RIVERA
Title or Position: EXECUTIVE DIRECTOR
Credential: LCDO
Phone: 787-653-3434