Healthcare Provider Details

I. General information

NPI: 1669725990
Provider Name (Legal Business Name): CENTRO MEDICO DEL TURABO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LUIS MUNOZ MARIN AVE.
CAGUAS PR
00725-4081
US

IV. Provider business mailing address

PO BOX 4980
CAGUAS PR
00726-4980
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-3434
  • Fax: 787-653-1280
Mailing address:
  • Phone: 787-653-3434
  • Fax: 787-653-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

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