Healthcare Provider Details

I. General information

NPI: 1528022027
Provider Name (Legal Business Name): CENTRO OFTALMOLOGICO METROPOLITANO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO #1250 CAPARRA TERRACE CENTRO OFTALMOLOGICO METROPOLITANO CSP
SAN JUAN PR
00922
US

IV. Provider business mailing address

PO BOX 10431 CENTRO OFTALMOLOGICO METROPOLITANO CSP
SAN JUAN PR
00922-0431
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-2565
  • Fax: 787-782-9524
Mailing address:
  • Phone: 787-781-2565
  • Fax: 787-782-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. LYDIA I TORRES
Title or Position: CFO
Credential:
Phone: 787-781-2565