Provider Demographics
NPI:1417239336
Name:CENTRO DE SERVICIOS DE REUMATOLOGIA PSC
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS DE REUMATOLOGIA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-850-6005
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1447
Mailing Address - Country:US
Mailing Address - Phone:787-850-6005
Mailing Address - Fax:787-852-5449
Practice Address - Street 1:114 CALLE ANTONIO LOPEZ S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4249
Practice Address - Country:US
Practice Address - Phone:787-850-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8410261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44009Medicare UPIN