Provider Demographics
NPI:1114328663
Name:CENTRO DE TRATAMIENTO PRIMARIO DEL ATLANTICO
Entity Type:Organization
Organization Name:CENTRO DE TRATAMIENTO PRIMARIO DEL ATLANTICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:POLANSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-608-8047
Mailing Address - Street 1:HC 4 BOX 13771
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR. 123 KM. 73
Practice Address - Street 2:BO. HATO VIEJO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9223
Practice Address - Country:US
Practice Address - Phone:787-608-8047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17871208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty