Provider Demographics
NPI:1376953695
Name:SALA URG CSM
Entity Type:Organization
Organization Name:SALA URG CSM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOYKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-795-2935
Mailing Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Mailing Address - Street 2:SEPTIMA SECCION LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3634
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:SEPTIMA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-784-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CSM SERVICIOS DE CUIDADO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085469Medicare PIN