Healthcare Provider Details

I. General information

NPI: 1104961903
Provider Name (Legal Business Name): CENTRO DE SERVICIOS MEDICOS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM LEVITTOWN
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

PO BOX 51513
TOA BAJA PR
00950-1513
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax: 787-784-0680
Mailing address:
  • Phone: 787-795-4810
  • Fax: 787-784-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number613
License Number StatePR

VIII. Authorized Official

Name: RAFAEL L ROIG
Title or Position: PRESIDENT
Credential:
Phone: 787-795-4810