=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912997768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTA SALUD COMMUNITY HEALTH CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2005
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE MUNOZ RIVERA
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-823-5555
-----------------------------------------------------
Fax | 787-823-2990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 638
-----------------------------------------------------
City | RINCON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00677-0638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-823-5555
-----------------------------------------------------
Fax | 787-823-2990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | LAURA M QUINONES TORRES
-----------------------------------------------------
Credential | LICENCIADA
-----------------------------------------------------
Telephone | 787-823-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 57
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------