Provider Demographics
NPI:1073808176
Name:CONCILIO DE SALUD INTEGRAL DE LOIZA
Entity Type:Organization
Organization Name:CONCILIO DE SALUD INTEGRAL DE LOIZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-876-2042
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0509
Mailing Address - Country:US
Mailing Address - Phone:787-876-2042
Mailing Address - Fax:787-256-1900
Practice Address - Street 1:CARRETERA #188 INT #187
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:787-256-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty