Healthcare Provider Details

I. General information

NPI: 1700099587
Provider Name (Legal Business Name): CENTRO MEDICO DEL TURABO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LUIS MUNOZ MARIN URB MARIOLGA HIMA SAN PABLO CAGUAS
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 4980
CAGUAS PR
00726-4980
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-3434
  • Fax: 787-961-1901
Mailing address:
  • Phone: 787-653-3434
  • Fax: 787-961-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number9670
License Number StatePR

VIII. Authorized Official

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