Provider Demographics
NPI:1225287394
Name:COOPERATIVA DE SERVICIOS MEDICOS DE PUERTO RICO
Entity Type:Organization
Organization Name:COOPERATIVA DE SERVICIOS MEDICOS DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MISS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:787-882-5705
Mailing Address - Street 1:PO BOX 5264
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5264
Mailing Address - Country:US
Mailing Address - Phone:787-882-5705
Mailing Address - Fax:787-882-5705
Practice Address - Street 1:168 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4814
Practice Address - Country:US
Practice Address - Phone:787-882-5705
Practice Address - Fax:787-882-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty