Provider Demographics
NPI:1114345469
Name:CLINICA FAMILIAR COTO LAUREL INC
Entity Type:Organization
Organization Name:CLINICA FAMILIAR COTO LAUREL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-1005
Mailing Address - Street 1:1 CALLE DEL PARQUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0383
Mailing Address - Country:US
Mailing Address - Phone:787-848-1005
Mailing Address - Fax:787-840-8269
Practice Address - Street 1:1 CALLE DEL PARQUE
Practice Address - Street 2:SUITE 1 COTO LAUREL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780-2151
Practice Address - Country:US
Practice Address - Phone:787-848-1005
Practice Address - Fax:787-840-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7179261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08361Medicare UPIN