Healthcare Provider Details

I. General information

NPI: 1093475675
Provider Name (Legal Business Name): CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ANTONIO R BARCELO # 5
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 907
HATILLO PR
00659-0907
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-4190
  • Fax:
Mailing address:
  • Phone: 787-898-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. LORENA D TORRES MERCADO
Title or Position: CEO
Credential:
Phone: 787-898-4190