Provider Demographics
NPI:1306226899
Name:CENTRO SENOLOGIA DRA MAGDA COSTA
Entity Type:Organization
Organization Name:CENTRO SENOLOGIA DRA MAGDA COSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-860-1642
Mailing Address - Street 1:AVENIDA CONQUISTADOR B1
Mailing Address - Street 2:URBANIZACION VEVE CALZADA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA CONQUISTADOR B1
Practice Address - Street 2:URBANIZACION VEVE CALZADA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0000
Practice Address - Country:US
Practice Address - Phone:787-860-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0025953OtherMEDICARE