Provider Demographics
NPI:1093851008
Name:CORPORACION PROFESIONAL DE SERVICIOS DE SALUD
Entity Type:Organization
Organization Name:CORPORACION PROFESIONAL DE SERVICIOS DE SALUD
Other - Org Name:GRUPO MEDICO DE MANATI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-6161
Mailing Address - Street 1:A13 CALLE VENDIG
Mailing Address - Street 2:URB. SAN SALVADOR
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-5396
Mailing Address - Country:US
Mailing Address - Phone:787-884-6161
Mailing Address - Fax:787-884-6966
Practice Address - Street 1:A13 CALLE VENDIG
Practice Address - Street 2:URB. SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5396
Practice Address - Country:US
Practice Address - Phone:787-884-6161
Practice Address - Fax:787-884-6966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty