Provider Demographics
NPI:1407874431
Name:CENTRO PREVENTIVO DE CUIDADO PULMONAR
Entity Type:Organization
Organization Name:CENTRO PREVENTIVO DE CUIDADO PULMONAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA ESQUERDO
Authorized Official - Suffix:
Authorized Official - Credentials:RRT,RSPGST
Authorized Official - Phone:787-795-6542
Mailing Address - Street 1:2681 BOULEVARD AVE.
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-795-6542
Mailing Address - Fax:787-795-5406
Practice Address - Street 1:2681 BOULEVARD AVE.
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-6542
Practice Address - Fax:787-795-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary DiagnosticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082765Medicare PIN