Provider Demographics
NPI:1275812935
Name:CENTRO MEDICO DEL TURABO, INC.
Entity Type:Organization
Organization Name:CENTRO MEDICO DEL TURABO, INC.
Other - Org Name:NOVA INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-653-2219
Mailing Address - Street 1:PO BOX 3968
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3968
Mailing Address - Country:US
Mailing Address - Phone:787-720-1000
Mailing Address - Fax:787-653-3535
Practice Address - Street 1:70 CALLE SANTA CRUZ
Practice Address - Street 2:PLAZA SAN PABLO II
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7052
Practice Address - Country:US
Practice Address - Phone:787-720-1000
Practice Address - Fax:787-653-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 3336H0001X
PR10071251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6603370001OtherMEDICARE PTAN
PR6603370001Medicare PIN