Provider Demographics
NPI:1407128226
Name:MED CENTRO, INC.
Entity Type:Organization
Organization Name:MED CENTRO, INC.
Other - Org Name:CONSEJO DE SALUD DE PUERTO RICO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON-SALICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHNM
Authorized Official - Phone:787-843-9393
Mailing Address - Street 1:P.O. BOX 220
Mailing Address - Street 2:
Mailing Address - City:MERCEDITO
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0220
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:787-841-0077
Practice Address - Street 1:1034 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1115
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:787-841-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0026172Medicare PIN