Provider Demographics
NPI:1376569434
Name:CENTROPOLIMENONITA DE COAMO
Entity Type:Organization
Organization Name:CENTROPOLIMENONITA DE COAMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:CANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-825-5835
Mailing Address - Street 1:13 CALLE MARIO BRASCHI
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-2501
Mailing Address - Country:US
Mailing Address - Phone:787-825-5835
Mailing Address - Fax:787-803-1999
Practice Address - Street 1:13 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2501
Practice Address - Country:US
Practice Address - Phone:787-825-5835
Practice Address - Fax:787-803-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty