Provider Demographics
NPI:1407563018
Name:PRIME MEDICAL CENTER CSP
Entity Type:Organization
Organization Name:PRIME MEDICAL CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MARTINEZ MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-861-4800
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0598
Mailing Address - Country:US
Mailing Address - Phone:787-861-0547
Mailing Address - Fax:787-861-0547
Practice Address - Street 1:47 BARCELO ST.
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-861-0547
Practice Address - Fax:787-861-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8366OtherMEDICAL LICENSE NUMBER