MEDICARE: CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA (COSSMA)

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1134374036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA (COSSMA)

Provider Business Mailing Address
First Line	:	PO BOX 1330
Second Line	:	AVE. EL JIBARO CARR. 172 KM. 13.5
City	:	CIDRA
State	:	PR
Zip	:	00739-1330
Country	:	US
Telephone Number	:	787-739-8182
Fax Number	:	787-739-8190

Provider Business Practice Location Address
First Line	:	AVE. EL JIBARO KM. 13.5
Second Line	:	CARR. 172
City	:	CIDRA
State	:	PR
Zip	:	00739-1330
Country	:	US
Telephone Number	:	787-739-8182
Fax Number	:	787-739-8190

Authorized Official
Title or Position	:	EXECUTOVE DIRECTOR
Name	:	MS. ISOLINA MIRANDA
Credential	:
Telephone Number	:	787-739-8182

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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