Healthcare Provider Details

I. General information

NPI: 1992072300
Provider Name (Legal Business Name): MED CENTRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 AVE HOSTOS
PONCE PR
00716-1115
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 Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number1618
License Number StatePR

VIII. Authorized Official

Name: MR. ALLAN CINTRON-SALICHS
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA, MHCM
Phone: 787-843-9393