Provider Demographics
NPI:1114680618
Name:MED CENTRO INC.
Entity Type:Organization
Organization Name:MED CENTRO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENERIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-843-9393
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0220
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:
Practice Address - Street 1:1046 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1118
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-841-0077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED CENTRO INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy