Healthcare Provider Details

I. General information

NPI: 1467767079
Provider Name (Legal Business Name): CENTRO DE SERVICIOS MEDICOS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIZZIE GRAHAM HF16 SEPTIMA SECCION LEVITTOWN
TOA BAJA PR
00949-0000
US

IV. Provider business mailing address

LIZZIE GRAHAM HF16 SEPTIMA SECCION LEVITTOWN
TOA BAJA PR
00949-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax: 787-784-0680
Mailing address:
  • Phone: 787-795-2935
  • Fax: 787-784-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number51
License Number StatePR

VIII. Authorized Official

Name: MR. RAFAEL L ROIG
Title or Position: PRESIDENTE
Credential:
Phone: 787-795-4810