Provider Demographics
NPI:1467767079
Name:CENTRO DE SERVICIOS MEDICOS INC
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS MEDICOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-4810
Mailing Address - Street 1:LIZZIE GRAHAM HF16 SEPTIMA SECCION
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-0000
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:LIZZIE GRAHAM HF16 SEPTIMA SECCION
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-0000
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-784-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SERVICIOS MEDICOS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-09
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR51OtherLICENCIA