Healthcare Provider Details

I. General information

NPI: 1518266642
Provider Name (Legal Business Name): CENTRO 4 MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXPRESO TRUJILLO ALTO, ESQUINA SAINT JUST OFICINA 205
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

PO BOX 1629
TRUJILLO ALTO PR
00977-1629
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-1632
  • Fax: 787-760-9074
Mailing address:
  • Phone: 787-760-1632
  • Fax: 787-760-9074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4717
License Number StatePR

VIII. Authorized Official

Name: DR. EFRAIN SANCHEZ
Title or Position: DOCTOR
Credential: M.D.
Phone: 787-760-1632