=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316269079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRO DE EPIDEMIOLOGIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2010
-----------------------------------------------------
Last Update Date | 02/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE ISABEL II ESQUINA DEGETAU BAYAMON PUEBLO
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-269-7565
-----------------------------------------------------
Fax | 787-269-5230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1588
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00960-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-269-7565
-----------------------------------------------------
Fax | 787-269-5230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR EJECUTIVA
-----------------------------------------------------
Name | MRS. DEBORAH D. MEDINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-269-7565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------