MEDICARE: CENTRO MEDICO LA ESPERANZA,P.S.C.

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	174400000X	Specialist	16181	PR

General Provider Information

NPI Number	:	1750719555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO MEDICO LA ESPERANZA,P.S.C.

Provider Business Mailing Address
First Line	:	604 CALLE MUNOZ RIVERA
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-1709
Country	:	US
Telephone Number	:	787-836-3409
Fax Number	:	787-836-3409

Provider Business Practice Location Address
First Line	:	604 CALLE MUNOZ RIVERA
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624-1709
Country	:	US
Telephone Number	:	787-836-3409
Fax Number	:	787-836-3409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICIA ESPERANZA MATOS MOQUETE
Credential	:	M.D.
Telephone Number	:	787-836-3409

Provider Enumeration Date	:	10/15/2013
Last Update Date	:	10/15/2013

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Directions to “CENTRO MEDICO LA ESPERANZA,P.S.C. ” Practice Location

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