Healthcare Provider Details

I. General information

NPI: 1487378295
Provider Name (Legal Business Name): CENTRO DE MEDICINA PRIMARIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #183 KM 19.3 BARRIO MONTONES
LAS PIEDRAS PR
00771
US

IV. Provider business mailing address

PO BOX 1475
LAS PIEDRAS PR
00771-1475
US

V. Phone/Fax

Practice location:
  • Phone: 787-679-6965
  • Fax:
Mailing address:
  • Phone: 787-679-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RONALD SERRANO
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-679-6965