Healthcare Provider Details

I. General information

NPI: 1124222682
Provider Name (Legal Business Name): NEOMED CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE CONDADO
SAN LORENZO PR
00754-4214
US

IV. Provider business mailing address

PO BOX 1277
GURABO PR
00778-1277
US

V. Phone/Fax

Practice location:
  • Phone: 787-737-2311
  • Fax: 787-737-0244
Mailing address:
  • Phone: 787-737-2311
  • Fax: 787-737-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSA T CASTRO-AVILA
Title or Position: CEO
Credential: M.D.
Phone: 787-737-2311