Provider Demographics
NPI:1235432584
Name:CORPORACION PROFESIONAL SALUD
Entity Type:Organization
Organization Name:CORPORACION PROFESIONAL SALUD
Other - Org Name:CORPORACION PROFESIONAL SALUD FEMENINA EN EXCELENCIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:VICENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-850-1695
Mailing Address - Street 1:PO BOX 9190
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9190
Mailing Address - Country:US
Mailing Address - Phone:787-850-1695
Mailing Address - Fax:787-850-1695
Practice Address - Street 1:AVE RAFAEL ARROYO RIOS #7
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-850-1695
Practice Address - Fax:787-850-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4675302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization