Provider Demographics
NPI:1467681809
Name:CENTRO DE HERIDAS, CORP.
Entity Type:Organization
Organization Name:CENTRO DE HERIDAS, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-632-4780
Mailing Address - Street 1:PO BOX 1954
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1954
Mailing Address - Country:US
Mailing Address - Phone:787-632-4780
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL DE LA CONCEPCION CARR. 2 KM. 172
Practice Address - Street 2:SUITE 103 TORRE SAN VICENTE DE PAUL PRIMER PISO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-632-4780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service