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General NPI Number Information
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NPI Number | 1417239336
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Entity Type | Organization
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Legal Business Name | CENTRO DE SERVICIOS DE REUMATOLOGIA PSC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 114 CALLE ANTONIO LOPEZ S
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City | HUMACAO
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State | PR
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Zip | 00791-4249
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Country | US
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Telephone | 787-850-6005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | JUNCOS
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State | PR
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Zip | 00777-1447
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Country | US
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Telephone | 787-850-6005
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Fax | 787-852-5449
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Authorized Official
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Title or Position | OWNER
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Name | DR. JORGE A MUNDO
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Credential | M.D.
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Telephone | 787-850-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 8410
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License Number State | PR
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