Provider Demographics
NPI:1235394305
Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD,INC.
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-822-2170
Mailing Address - Street 1:3 CALLE ANTONIO ALCAZAR
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-1912
Mailing Address - Country:US
Mailing Address - Phone:787-822-2170
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE ANTONIO ALCAZAR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-1912
Practice Address - Country:US
Practice Address - Phone:787-822-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SERVICIOS PRIMARIOS DE SALUD,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-28
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR114261QC1500X
PR735291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0680461OtherCLIA LAB.
PR4020107OtherNABP
PR80090Medicare PIN
PR30752Medicare PIN