Healthcare Provider Details

I. General information

NPI: 1659406015
Provider Name (Legal Business Name): CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AVE DR SUSONI
HATILLO PR
00659-1847
US

IV. Provider business mailing address

116 AVE DR SUSONI
HATILLO PR
00659-1847
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4190
  • Fax: 787-262-3984
Mailing address:
  • Phone: 787-898-4190
  • Fax: 787-262-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-1887
License Number StatePR

VIII. Authorized Official

Name: MR. ARMANDO LEGARRETA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-898-4190