Provider Demographics
NPI:1205036951
Name:CENTROSALUD PC
Entity Type:Organization
Organization Name:CENTROSALUD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:D
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-531-8800
Mailing Address - Street 1:6063 MT MORIAH RD EXT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2644
Mailing Address - Country:US
Mailing Address - Phone:901-531-8800
Mailing Address - Fax:901-531-8801
Practice Address - Street 1:6063 MOUNT MORIAH ROAD EXT
Practice Address - Street 2:SUITE 4
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2644
Practice Address - Country:US
Practice Address - Phone:901-531-8800
Practice Address - Fax:901-531-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD653723207R00000X
TNMD29316207R00000X
TNMD023823208000000X
TNAPN8252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty