Provider Demographics
NPI:1467839159
Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Entity Type:Organization
Organization Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Other - Org Name:CLINICA SATELITE SANTA ISABEL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-839-4320
Mailing Address - Street 1:32 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0000
Mailing Address - Country:US
Mailing Address - Phone:787-839-4320
Mailing Address - Fax:787-845-5841
Practice Address - Street 1:32 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-0000
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:787-845-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00757OtherPHARMACY