Healthcare Provider Details

I. General information

NPI: 1992848907
Provider Name (Legal Business Name): CENTRO MEDICO DEL TURABO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIMA SAN PABLO FAJARDO EDIF ANTIGUO OPD PISO 2
FAJARDO PR
00738
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: 787-653-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number6119
License Number StatePR

VIII. Authorized Official

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