Healthcare Provider Details

I. General information

NPI: 1407563018
Provider Name (Legal Business Name): PRIME MEDICAL CENTER CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 12/18/2024
Certification Date: 10/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BARCELO ST.
MAUNABO PR
00707
US

IV. Provider business mailing address

PO BOX 598
MAUNABO PR
00707-0598
US

V. Phone/Fax

Practice location:
  • Phone: 787-861-0547
  • Fax: 787-861-0547
Mailing address:
  • Phone: 787-861-0547
  • Fax: 787-861-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PEDRO N CADIZ MIRANDA
Title or Position: GENERAL PRACTICE
Credential: MD
Phone: 787-861-4800