Provider Demographics
NPI:1083922678
Name:COSTA SALUD CHC ER RINCON
Entity Type:Organization
Organization Name:COSTA SALUD CHC ER RINCON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-823-0440
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0638
Mailing Address - Country:US
Mailing Address - Phone:787-823-5555
Mailing Address - Fax:787-823-2990
Practice Address - Street 1:CALLE MUNOZ RIVERA 28
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-823-5555
Practice Address - Fax:787-823-2990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COSTA SALUD CHC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-17
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care