Provider Demographics
NPI:1164944500
Name:METRO PAVIA HEALTHCARE CENTERS, INC.
Entity Type:Organization
Organization Name:METRO PAVIA HEALTHCARE CENTERS, INC.
Other - Org Name:CENTRO DE DIABETES CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERACIONAL SENIOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-230-7530
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:PMB 455
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-230-7530
Mailing Address - Fax:
Practice Address - Street 1:CARR #3 KM 13.4
Practice Address - Street 2:BO. CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-230-7530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR52261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center