Provider Demographics
NPI:1366630360
Name:CENTRO DE MEDICINA PRIMARIA BAYAMON INC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PRIMARIA BAYAMON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-9944
Mailing Address - Street 1:1168 CALLE FINLANDIA
Mailing Address - Street 2:URB. PLAZA DE LAS FUENTES
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3809
Mailing Address - Country:US
Mailing Address - Phone:787-269-9944
Mailing Address - Fax:787-269-9944
Practice Address - Street 1:D54 AVE LAUREL
Practice Address - Street 2:URB. SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4661
Practice Address - Country:US
Practice Address - Phone:787-269-9944
Practice Address - Fax:787-269-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR173571261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9090173OtherHUMANA GOLD CHOICE
PR3834OtherPMC PREFERRED MEDICAL CHO
PR22373OtherSSS
PR500437 EOtherMEDICARE Y MUCHO MAS
PR0022373OtherMEDICARE