Provider Demographics
NPI:1235179532
Name:CENTRO DE SALUD DE LARES, INC.
Entity Type:Organization
Organization Name:CENTRO DE SALUD DE LARES, INC.
Other - Org Name:CENTRO INTEGRADOS DE SERVICIOS DE SALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2727
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0379
Mailing Address - Country:US
Mailing Address - Phone:787-897-2727
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:CALLE RAFOLS
Practice Address - Street 2:ESQUINA DEL CARMEN
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-895-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QF0400X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084979Medicare PIN