=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114680618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED CENTRO INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2021
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1046 AVE HOSTOS
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00716-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-843-9393
-----------------------------------------------------
Fax | 787-841-0077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 220
-----------------------------------------------------
City | MERCEDITA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00715-0220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-843-9393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ALLAN CINTRON SALICHS
-----------------------------------------------------
Credential | MBA, MHCM
-----------------------------------------------------
Telephone | 787-843-9393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------