Healthcare Provider Details

I. General information

NPI: 1275161572
Provider Name (Legal Business Name): MED CENTRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KM HM 6-5 CARR 385 BO CUEVAS
PENUELAS PR
00624
US

IV. Provider business mailing address

PO BOX 220
MERCEDITA PR
00715-0220
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9393
  • Fax: 787-841-0077
Mailing address:
  • Phone: 787-843-9393
  • Fax: 787-841-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLAN CINTRON
Title or Position: EXECUTIVE DRIECTOR
Credential:
Phone: 787-843-9393