Healthcare Provider Details

I. General information

NPI: 1538432042
Provider Name (Legal Business Name): MED CENTRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 149 KM 55.2
VILLALBA PR
00766
US

IV. Provider business mailing address

PO BOX 220
MERCEDITA PR
00715-0220
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9393
  • Fax: 787-841-0077
Mailing address:
  • Phone: 787-843-9393
  • Fax: 787-841-0077

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: MR. ALLAN CINTRON-SALICHS
Title or Position: EXECUTIVE DIRECTOR
Credential: MHC, HHCH
Phone: 787-843-9393