Healthcare Provider Details

I. General information

NPI: 1417100389
Provider Name (Legal Business Name): CORPORACION DE SALUD ASEGURADA POR NUESTRA ORGANIZACION SOLIDARIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAFAEL CORDERO AVENUE, TROCHE ST.
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 1025
CAGUAS PR
00726-1025
US

V. Phone/Fax

Practice location:
  • Phone: 787-745-3544
  • Fax: 787-746-1780
Mailing address:
  • Phone: 787-745-3544
  • Fax: 787-746-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number18-F-2638
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number20-F-3538
License Number StatePR

VIII. Authorized Official

Name: MR. CESAR MONTIJO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-745-3544