Provider Demographics
NPI:1295032845
Name:CLINICA PAP POLICLINICA
Entity Type:Organization
Organization Name:CLINICA PAP POLICLINICA
Other - Org Name:POLICLINICA GENERAL COAMO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-205-4040
Mailing Address - Street 1:18 CALLE MARIO BRASCHI
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2526
Mailing Address - Country:US
Mailing Address - Phone:787-825-1020
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2526
Practice Address - Country:US
Practice Address - Phone:787-825-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLICLINICA GENERAL COAMO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6930261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81704Medicare UPIN