Healthcare Provider Details

I. General information

NPI: 1720455876
Provider Name (Legal Business Name): CIMA HMO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. AGUSTIN RAMOS KM 1.4 INTERIOR BO MORA
ISABELA PR
00662
US

IV. Provider business mailing address

PO BOX 484
ISABELA PR
00662-0484
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-2705
  • Fax: 787-830-8866
Mailing address:
  • Phone: 787-407-4424
  • Fax: 787-830-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS RAFAEL NIEVES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-407-4424