MEDICARE: CENTRALIS MED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	103T00000X	Psychologist
3	207QG0300X	Geriatric Medicine (Family Medicine) Physician
4	2084P0804X	Child & Adolescent Psychiatry Physician	20744	PR

General Provider Information

NPI Number	:	1083151757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRALIS MED LLC

Provider Business Mailing Address
First Line	:	URB CONDADO VIEJO H17
Second Line	:	CALLE JOSE VILLARES
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-648-2332
Fax Number	:	787-993-1656

Provider Business Practice Location Address
First Line	:	URB CONDADO VIEJO H17
Second Line	:	CALLE JOSE VILLARES
City	:	CAGUAS
State	:	PR
Zip	:	00725-2463
Country	:	US
Telephone Number	:	787-510-6187
Fax Number	:	787-993-1656

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGEL MARTINEZ
Credential	:
Telephone Number	:	787-648-2332

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	02/04/2026

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