Provider Demographics
NPI:1083603138
Name:TELECOM DOCTORS, CSP
Entity Type:Organization
Organization Name:TELECOM DOCTORS, CSP
Other - Org Name:BODY HABITUS OBESITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE & MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOS
Authorized Official - Middle Name:AURELIO
Authorized Official - Last Name:DVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-748-5306
Mailing Address - Street 1:100 GRAND BLVD
Mailing Address - Street 2:SUITE 112 MSC 158
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5955
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-748-5297
Practice Address - Street 1:#100 GRAND BLVD PASEOS
Practice Address - Street 2:SUITE 112 MSC 158
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5955
Practice Address - Country:US
Practice Address - Phone:787-748-5306
Practice Address - Fax:787-748-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10807261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PROTH000Medicare UPIN