Provider Demographics
NPI:1285184366
Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-839-4320
Mailing Address - Street 1:99 CALLE GUILLERMO RIEFKOHL
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723
Mailing Address - Country:US
Mailing Address - Phone:787-829-4320
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:99 CALLE GUILLERMO RIEFKOHL
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-829-4320
Practice Address - Fax:787-271-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR55261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080082Other072016