Healthcare Provider Details

I. General information

NPI: 1902456221
Provider Name (Legal Business Name): CENTRO ARARAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CALLE EUROPA STE 301
SAN JUAN PR
00909-2757
US

IV. Provider business mailing address

PO BOX 7793
PONCE PR
00732-7793
US

V. Phone/Fax

Practice location:
  • Phone: 787-496-0818
  • Fax: 787-982-6464
Mailing address:
  • Phone: 787-284-5884
  • Fax: 787-651-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVAN MELENDEZ-RIVERA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-284-5884