Healthcare Provider Details

I. General information

NPI: 1366654337
Provider Name (Legal Business Name): CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 GUILLERMO RIEFKHOL STREET
PATILLAS PR
00723-0697
US

IV. Provider business mailing address

99 GUILLERMO RIEFKHOL STREET
PATILLAS PR
00723-0697
US

V. Phone/Fax

Practice location:
  • Phone: 787-839-4320
  • Fax: 787-271-0004
Mailing address:
  • Phone: 787-839-4320
  • Fax: 787-271-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number55
License Number StatePR

VIII. Authorized Official

Name: MRS. MILDRED MOREL ORTIZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-839-4320