Healthcare Provider Details

I. General information

NPI: 1235394305
Provider Name (Legal Business Name): CENTRO DE SERVICIOS PRIMARIOS DE SALUD,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE ANTONIO ALCAZAR
FLORIDA PR
00650-1912
US

IV. Provider business mailing address

3 CALLE ANTONIO ALCAZAR
FLORIDA PR
00650-1912
US

V. Phone/Fax

Practice location:
  • Phone: 787-822-2170
  • Fax:
Mailing address:
  • Phone: 787-822-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number114
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number735
License Number StatePR

VIII. Authorized Official

Name: MRS. ROSA AGOSTINI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-822-2170