Provider Demographics
NPI:1285847350
Name:CENTRO RENAL DEL SUR CORP
Entity Type:Organization
Organization Name:CENTRO RENAL DEL SUR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COSME
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-8201
Mailing Address - Street 1:P O BOX 331990
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-1990
Mailing Address - Country:US
Mailing Address - Phone:787-841-8201
Mailing Address - Fax:
Practice Address - Street 1:3011 AVE FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3637
Practice Address - Country:US
Practice Address - Phone:787-841-8201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0088711Medicare PIN