Healthcare Provider Details

I. General information

NPI: 1346214129
Provider Name (Legal Business Name): RS CENTRO MEDICINA AVANZADA, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE BOBBY CAPO
COAMO PR
00769-2416
US

IV. Provider business mailing address

20 CALLE BOBBY CAPO
COAMO PR
00769-2416
US

V. Phone/Fax

Practice location:
  • Phone: 787-803-0040
  • Fax: 787-803-0070
Mailing address:
  • Phone: 787-803-0040
  • Fax: 787-803-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number04PU7-00000-04656
License Number StatePR

VIII. Authorized Official

Name: MRS. LEYDA LOPEZ MARTINEZ
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 787-803-0040