Provider Demographics
NPI:1093743023
Name:COSTA SALUD COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:COSTA SALUD COMMUNITY HEALTH CENTER
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:787-823-5555
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:787-823-2390
Practice Address - Street 1:MUNOZ RIVERA STREET #28
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-0638
Practice Address - Country:US
Practice Address - Phone:787-823-5555
Practice Address - Fax:787-823-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-00593336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4020880OtherNAPP