Provider Demographics
NPI:1073805578
Name:CENTRO MEDICO POLICLINICAS DE PUERTO RICO, INC.
Entity Type:Organization
Organization Name:CENTRO MEDICO POLICLINICAS DE PUERTO RICO, INC.
Other - Org Name:POLICLINICAS DE PONCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-225-2233
Mailing Address - Street 1:PMB261 BOX 7105
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-284-1566
Mailing Address - Fax:787-290-6689
Practice Address - Street 1:PLAZOLETA PONCE CASH & CARRY, LOCAL # 4
Practice Address - Street 2:URB. MORRELL CAMPOS
Practice Address - City:PONCE,
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-812-3194
Practice Address - Fax:787-290-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization