Healthcare Provider Details

I. General information

NPI: 1265682884
Provider Name (Legal Business Name): CENTRO DE SALUD DE LARES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 03/20/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE RAFOLS ESQUINA DEL CARMEN 114
QUEBRADILLAS PR
00678
US

IV. Provider business mailing address

PO BOX 379
LARES PR
00669-0379
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-2727
  • Fax: 787-895-1540
Mailing address:
  • Phone: 787-897-2727
  • Fax: 787-897-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number142
License Number StatePR

VIII. Authorized Official

Name: DAMARIS RODRIGUEZ SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-897-2727