Provider Demographics
NPI:1366839847
Name:COOPERATIVA DE SERVICIOS DE SALUD DE PR
Entity Type:Organization
Organization Name:COOPERATIVA DE SERVICIOS DE SALUD DE PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDESTOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-762-9424
Mailing Address - Street 1:AL5 VIA ELENA
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3901
Mailing Address - Country:US
Mailing Address - Phone:787-762-9424
Mailing Address - Fax:
Practice Address - Street 1:AL5 VIA ELENA
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3901
Practice Address - Country:US
Practice Address - Phone:787-762-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR278302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization