Provider Demographics
NPI:1114297462
Name:CENTRO DE MEDICINA PRIMARIA FAMILIAR DRA MAYRZ Z NEGRON
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PRIMARIA FAMILIAR DRA MAYRZ Z NEGRON
Other - Org Name:CENTRO DE MEDICINA PRIMARIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:NEGRON MONSERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-998-0639
Mailing Address - Street 1:CALLE JOSE FERNANDEZ #6
Mailing Address - Street 2:4 TO PISO EDIT FERNANDEZ MEDICAL BUILDING
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-998-0639
Mailing Address - Fax:787-998-4516
Practice Address - Street 1:CALLE JOSE FERNANDEZ #6
Practice Address - Street 2:4 TO PISO EDIT FERNANDEZ MEDICAL BUILDING
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-998-0639
Practice Address - Fax:787-998-4516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO MEDICINA PRIMARIA FAMILIAR DRA MAYRW Z NEGRON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty