Provider Demographics
NPI:1083758163
Name:CENTRO MEDICO DEL TURABO INC
Entity Type:Organization
Organization Name:CENTRO MEDICO DEL TURABO INC
Other - Org Name:GRUPO EMERGENCIAS PEDIATRICAS FAJARDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-653-3434
Mailing Address - Street 1:PO BOX 4980
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-653-3434
Mailing Address - Fax:787-961-1901
Practice Address - Street 1:HIMA SAN PABLO FAJARDO
Practice Address - Street 2:AVE GENERAL VALERO 404
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-0505
Practice Address - Fax:787-655-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6893207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11744OtherMEDICAL LICENSE
PR6893OtherMEDICAL LICENSE
PR7291OtherMEDICAL LICENSE
PR14540OtherMEDICAL LICENSE
PR10792OtherMEDICAL LICENSE
PR12373OtherMEDICAL LICENSE
PR12929OtherMEDICAL LICENSE
PR10483OtherMEDICAL LICENSE
PR4494OtherMEDICAL LICENSE