Provider Demographics
NPI:1104206069
Name:CENTRO SERVICIOS DE SALUD TOA ALTA, LLC
Entity Type:Organization
Organization Name:CENTRO SERVICIOS DE SALUD TOA ALTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEC
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-520-8449
Mailing Address - Street 1:IF48 AVE LOMAS VERDES
Mailing Address - Street 2:ROYAL PALM
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3114
Mailing Address - Country:US
Mailing Address - Phone:787-520-8449
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-520-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care