Healthcare Provider Details

I. General information

NPI: 1720174014
Provider Name (Legal Business Name): CENTRO DE MEDICINA INTEGRAL DE MANATI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. COTTO #77 URBANIZACION FELIX CORDOVA DAVILA
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 4317
VEGA BAJA PR
00694-4317
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-0824
  • Fax:
Mailing address:
  • Phone: 787-854-0824
  • Fax: 787-884-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MARIBEL RODRIGUEZ ROMANACCE
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-884-4700