Healthcare Provider Details

I. General information

NPI: 1225797160
Provider Name (Legal Business Name): CORPORACION SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 2 KM 86.6 INTERIOR MARGINAL NORTE BO. PUEBLO
HATILLO PR
00659
US

IV. Provider business mailing address

PO BOX 907
HATILLO PR
00659-0907
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4190
  • Fax:
Mailing address:
  • Phone: 787-898-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YAZMIN SANTIAGO
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 787-898-4190