Provider Demographics
NPI:1285011924
Name:NEOMED CENTER, INC.
Entity Type:Organization
Organization Name:NEOMED CENTER, INC.
Other - Org Name:NEOMED CENTER - TRUJILLO ALTO LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-737-2311
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:130 CALLE CARITE
Practice Address - Street 2:URB. LAGO ALTO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-0244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEOMED CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR959291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84530Medicare UPIN