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General NPI Number Information
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NPI Number | 1942668561
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Entity Type | Organization
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Legal Business Name | CENTRO SERVICIOS DE SALUD TOA ALTA, LLC
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 16 CALLE BARCELO
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City | TOA ALTA
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State | PR
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Zip | 00953-2444
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Country | US
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Telephone | 787-241-4229
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Fax |
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Provider Business Mailing Address
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Address Line | IF48 AVE LOMAS VERDES
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City | BAYAMON
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State | PR
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Zip | 00956-3114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEC MANUELY RIVERA
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Credential | M.D.
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Telephone | 787-241-4229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 16122
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License Number State | PR
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