Healthcare Provider Details

I. General information

NPI: 1093357337
Provider Name (Legal Business Name): NEOMED CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET #31 KM 3.7 LOT #2
NAGUABO PR
00718
US

IV. Provider business mailing address

PO BOX 1278
GURABO PR
00778-1278
US

V. Phone/Fax

Practice location:
  • Phone: 787-737-2311
  • Fax: 787-737-2377
Mailing address:
  • Phone: 787-737-2311
  • Fax: 787-737-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSA T CASTRO-AVILA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 787-737-2311