Healthcare Provider Details

I. General information

NPI: 1558456616
Provider Name (Legal Business Name): CENTRO DE INVESTIGACION EDUCACION Y SERVICIOS MEDICOS PARA LA DIABETES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIMER PISO EDIF. DECANATO DE FARMACIA CENTRO MEDICO
SAN JUAN PR
00936-8344
US

IV. Provider business mailing address

PMB #87 PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-8283
  • Fax: 787-773-8303
Mailing address:
  • Phone: 787-773-8283
  • Fax: 787-773-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL JOSE BUSTELO SANCLEMENTE
Title or Position: DIRECTOR
Credential:
Phone: 787-753-8500