Healthcare Provider Details

I. General information

NPI: 1093743023
Provider Name (Legal Business Name): COSTA SALUD COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUNOZ RIVERA STREET #28
RINCON PR
00677-0638
US

IV. Provider business mailing address

PO BOX 638
RINCON PR
00677-0638
US

V. Phone/Fax

Practice location:
  • Phone: 787-823-5555
  • Fax: 787-823-2390
Mailing address:
  • Phone: 787-823-5555
  • Fax: 787-823-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number07-F-0059
License Number StatePR

VIII. Authorized Official

Name: MRS. SUSANA M PEREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-823-5555