MEDICARE: CENTRO MEDICO

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	261QA1903X	Ambulatory Surgical Clinic/Center	17541	PR
2	282N00000X	General Acute Care Hospital	17541	PR

General Provider Information

NPI Number	:	1235373952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO MEDICO

Provider Business Mailing Address
First Line	:	609 CUEVILLAS ST.
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:	787-525-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 CALLE CUEVILLAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-3250
Country	:	US
Telephone Number	:	787-525-0400
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	LUIS ANTONIO RODRIGUEZ-ESCOLA
Credential	:	MD
Telephone Number	:	787-525-0400

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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Directions to “CENTRO MEDICO ” Practice Location

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