Healthcare Provider Details

I. General information

NPI: 1104662790
Provider Name (Legal Business Name): CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE ANTONIO ALCAZAR
FLORIDA PR
00650-0368
US

IV. Provider business mailing address

3 CALLE ANTONIO ALCAZAR P.O.BOX 368
FLORIDA PR
00650-0368
US

V. Phone/Fax

Practice location:
  • Phone: 787-822-2170
  • Fax: 787-822-2454
Mailing address:
  • Phone: 787-822-2170
  • Fax: 787-822-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

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