Healthcare Provider Details

I. General information

NPI: 1922414812
Provider Name (Legal Business Name): CENTRO DE MEDICINA PREVENTIVA CERV,CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE LUIS M ALFARO
OROCOVIS PR
00720-4467
US

IV. Provider business mailing address

PO BOX 157
OROCOVIS PR
00720-0157
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-8085
  • Fax: 939-212-7459
Mailing address:
  • Phone: 787-868-8085
  • Fax: 939-212-7459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
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: DR. RODRIGUEZ EULOGIO CARLOS
Title or Position: MEDICO
Credential: M.D
Phone: 787-867-8085