MEDICARE: CENTRO DE ESPECIALIDADES MULTIPLES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	208D00000X	General Practice Physician
5	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1417552514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE ESPECIALIDADES MULTIPLES LLC

Provider Business Mailing Address
First Line	:	PO BOX 372346
Second Line	:
City	:	CAYEY
State	:	PR
Zip	:	00737-2346
Country	:	US
Telephone Number	:	787-738-6444
Fax Number	:	787-738-2445

Provider Business Practice Location Address
First Line	:	7 CALLE BALDORIOTY DE CASTRO
Second Line	:
City	:	CAYEY
State	:	PR
Zip	:	00736-3761
Country	:	US
Telephone Number	:	787-738-6444
Fax Number	:	787-738-2445

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ISAMUEL SANTOS ROALES
Credential	:	MD
Telephone Number	:	787-738-6444

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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