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General NPI Number Information
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NPI Number | 1285979633
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Entity Type | Organization
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Legal Business Name | CLINICA DE MEDICINA PRIMARIA DEL SUR.CSP
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | CARR 132, KM 24.3 NO. 8 CANAS
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-284-6934
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Fax |
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Provider Business Mailing Address
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Address Line | 442,CALLE HNOS SCHMIDT EST DEL GOLF CLUB
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City | PONCE
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State | PR
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Zip | 00730
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | MRS. SONIA A JOSE
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Credential |
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Telephone | 787-284-6934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 11906
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License Number State | PR
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