Provider Demographics
NPI:1417907502
Name:CENTRO DE SALUD DE LARES, INC.
Entity Type:Organization
Organization Name:CENTRO DE SALUD DE LARES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2727
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0379
Mailing Address - Country:US
Mailing Address - Phone:787-897-2727
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:ROAD 111 KM 1.9
Practice Address - Street 2:LOS PATRIOTAS AVE.
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0379
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-897-2725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SALUD DE LARES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCNC99-285261QF0400X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1000608OtherACAA
PR1511-1OtherASOCIACION MAESTROS-MEDIC
PR600099OtherPREFERRED HEALTH PLAN
PR030168OtherCRUZ AZUL
PR1511-3OtherASOCIACION MAESTROS-LAB
PR81009OtherTRIPLE
PR1511-2OtherASOCIACION MAESTROS-SE
PR=========Medicaid
PR1511-1OtherASOCIACION MAESTROS-MEDIC
PR=========OtherFIRST PLUS MEDICARE
PR1000608OtherACAA
PR1511-3OtherASOCIACION MAESTROS-LAB
PR81009OtherTRIPLE
PR600099OtherPREFERRED HEALTH PLAN
PR=========OtherPREFERRED MEDICARE CHOICE
PR030168OtherCRUZ AZUL
PR=========OtherCOSVI MED
PR=========OtherFIRST PLUS MEDICARE
PR0080074Medicare PIN
PR=========OtherHUMANA HEALTH PLAN