Provider Demographics
NPI:1346214129
Name:RS CENTRO MEDICINA AVANZADA, CORP
Entity Type:Organization
Organization Name:RS CENTRO MEDICINA AVANZADA, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEYDA
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-803-0040
Mailing Address - Street 1:20 CALLE BOBBY CAPO
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2416
Mailing Address - Country:US
Mailing Address - Phone:787-803-0040
Mailing Address - Fax:787-803-0070
Practice Address - Street 1:20 CALLE BOBBY CAPO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2416
Practice Address - Country:US
Practice Address - Phone:787-803-0040
Practice Address - Fax:787-803-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04PU7-00000-04656261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084976Medicare PIN