Provider Demographics
NPI:1225562499
Name:CORPORACION PARA EL DESARROLLO DE LA SALUD EN EL MUNICIPIO DE BAYAMON
Entity Type:Organization
Organization Name:CORPORACION PARA EL DESARROLLO DE LA SALUD EN EL MUNICIPIO DE BAYAMON
Other - Org Name:BAYAMON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BEHAR
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-995-1900
Mailing Address - Street 1:PO BOX 2759
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2759
Mailing Address - Country:US
Mailing Address - Phone:787-995-1900
Mailing Address - Fax:
Practice Address - Street 1:CALLE MANUEL F ROSSY ESQ DEGETAU ISABEL II
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-2759
Practice Address - Country:US
Practice Address - Phone:787-955-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084412Medicare UPIN