Provider Demographics
NPI:1497163893
Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.SI SATELLITE CLINI
Entity Type:Organization
Organization Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.SI SATELLITE CLINI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
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:787-845-5841
Mailing Address - Street 1:32 MUNOZ RIVERA STREET
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:787-845-5841
Mailing Address - Fax:
Practice Address - Street 1:32 MUNOZ RIVERA ST.
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:787-845-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080082Medicare UPIN