MEDICARE: CENTRO INTEGRADO DE TRATAMIENTOS DE SALUD

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	208D00000X	General Practice Physician	9193	PR

General Provider Information

NPI Number	:	1932478914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO INTEGRADO DE TRATAMIENTOS DE SALUD

Provider Business Mailing Address
First Line	:	1257 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1619
Country	:	US
Telephone Number	:	787-782-6736
Fax Number	:	787-781-1272

Provider Business Practice Location Address
First Line	:	1257 AVE AMERICO MIRANDA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1619
Country	:	US
Telephone Number	:	787-782-6736
Fax Number	:	787-781-1272

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. RAFAEL DOLORES FRIAS
Credential	:	M.D.
Telephone Number	:	787-717-8424

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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