Healthcare Provider Details

I. General information

NPI: 1073805578
Provider Name (Legal Business Name): CENTRO MEDICO POLICLINICAS DE PUERTO RICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZOLETA PONCE CASH & CARRY, LOCAL # 4 URB. MORRELL CAMPOS
PONCE PR
00732
US

IV. Provider business mailing address

PMB261 BOX 7105
PONCE PR
00732
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3194
  • Fax: 787-290-6689
Mailing address:
  • Phone: 787-284-1566
  • Fax: 787-290-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY G DROZ
Title or Position: EXECUTIVE DIRECTOR
Credential: M.H.S.A.
Phone: 787-225-2233