Provider Demographics
NPI:1376583567
Name:CENTRO DE POLISOMNOGRAFIA DEL SUROESTE
Entity Type:Organization
Organization Name:CENTRO DE POLISOMNOGRAFIA DEL SUROESTE
Other - Org Name:CPS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-856-8624
Mailing Address - Street 1:EDIF CENTRO PROFESIONAL DEL SUR CARR 121 KM 13.3
Mailing Address - Street 2:SECTOR CUATRO CALLES SUITE 205
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-856-8624
Mailing Address - Fax:787-856-8625
Practice Address - Street 1:CENTRO PROFESIONAL DEL SUR 2DO PISO CARR 121 KM 13.3
Practice Address - Street 2:SECTOR CUATRO CALLES SUITE 205
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-8624
Practice Address - Fax:787-856-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty