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General NPI Number Information
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NPI Number | 1407097744
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Entity Type | Organization
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Legal Business Name | CENTRO DE CONSULTORIA MEDICA,CSP
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | SS RODRIGUEZ 57 B
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City | GUANICA
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State | PR
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Zip | 00653
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Country | US
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Telephone | 787-821-6565
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Fax | 787-821-6565
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Provider Business Mailing Address
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Address Line | 57 SS RODRIGUEZ
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City | GUANICA
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State | PR
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Zip | 00653
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Country | US
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Telephone | 787-821-6565
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Fax | 787-821-6565
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN C MONTALVO
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Credential | M. D.
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Telephone | 787-821-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 16824
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License Number State | PR
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