Healthcare Provider Details

I. General information

NPI: 1760530760
Provider Name (Legal Business Name): CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA COSSMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE EL JIBARO CARR 172 KM 13 5
CIDRA PR
00739
US

IV. Provider business mailing address

PO BOX 1330
CIDRA PR
00739-1330
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax: 787-714-1444
Mailing address:
  • Phone: 787-739-8182
  • Fax: 787-739-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number18F2618
License Number StatePR

VIII. Authorized Official

Name: ISOLINA MIRANDA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-739-8182