Provider Demographics
NPI:1003203589
Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Entity Type:Organization
Organization Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Other - Org Name:CLINICA SATELITE MAUNABO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREL
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-839-4320
Mailing Address - Street 1:45 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-2146
Mailing Address - Country:US
Mailing Address - Phone:787-839-4320
Mailing Address - Fax:787-861-4320
Practice Address - Street 1:45 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2146
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:787-861-4320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMF366OtherPHARMACY