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General NPI Number Information
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NPI Number | 1366630360
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINA PRIMARIA BAYAMON INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | D54 AVE LAUREL URB. SANTA JUANITA
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City | BAYAMON
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State | PR
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Zip | 00956-4661
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Country | US
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Telephone | 787-269-9944
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Fax | 787-269-9944
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Provider Business Mailing Address
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Address Line | 1168 CALLE FINLANDIA URB. PLAZA DE LAS FUENTES
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City | TOA ALTA
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State | PR
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Zip | 00953-3809
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Country | US
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Telephone | 787-269-9944
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Fax | 787-269-9944
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. ROBERTO A RODRIGUEZ
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Credential | M.D.
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Telephone | 787-269-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 173571
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License Number State | PR
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