=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225762677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CS SF MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2022
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE KENNEDY INT
-----------------------------------------------------
City | MAUNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-983-5074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MANSIONES DE VISTAMAR MARINA 1126 MARBELLA
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00983-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-983-5074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NORBERT SEDA OLMO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-983-5074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------