Healthcare Provider Details

I. General information

NPI: 1407874431
Provider Name (Legal Business Name): CENTRO PREVENTIVO DE CUIDADO PULMONAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 BOULEVARD AVE. LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

2681 BOULEVARD AVE. LEVITTOWN
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-6542
  • Fax: 787-795-5406
Mailing address:
  • Phone: 787-795-6542
  • Fax: 787-795-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS IRMA C RIVERA ESQUERDO
Title or Position: ADMINISTRATOR
Credential: RRT,RSPGST
Phone: 787-795-6542