Healthcare Provider Details

I. General information

NPI: 1083151757
Provider Name (Legal Business Name): CENTRALIS MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB CONDADO VIEJO H17 CALLE JOSE VILLARES
CAGUAS PR
00725-2463
US

IV. Provider business mailing address

URB CONDADO VIEJO H17 CALLE JOSE VILLARES
CAGUAS PR
00725-2463
US

V. Phone/Fax

Practice location:
  • Phone: 787-510-6187
  • Fax: 787-993-1656
Mailing address:
  • Phone: 787-648-2332
  • Fax: 787-993-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20744
License Number StatePR

VIII. Authorized Official

Name: ANGEL MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-648-2332