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General NPI Number Information
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NPI Number | 1235373952
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 609 CALLE CUEVILLAS
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City | SAN JUAN
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State | PR
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Zip | 00907-3250
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Country | US
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Telephone | 787-525-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 609 CUEVILLAS ST.
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City | SAN JUAN
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State | PR
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Zip | 00907
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Country | US
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Telephone | 787-525-0400
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Fax |
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Authorized Official
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Title or Position | MD
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Name | LUIS ANTONIO RODRIGUEZ-ESCOLA
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Credential | MD
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Telephone | 787-525-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 17541
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 17541
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License Number State | PR
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