Provider Demographics
NPI:1497168124
Name:PROFESSIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORDERO SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-743-1985
Mailing Address - Street 1:698 VEREDAS LOS CEDROS
Mailing Address - Street 2:URB. VEREDAS DE NAVARRO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-6098
Mailing Address - Country:US
Mailing Address - Phone:787-743-1985
Mailing Address - Fax:787-744-6276
Practice Address - Street 1:CARR. 931 KM 5.5
Practice Address - Street 2:PRADERAS SHOPPING CENTER
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-743-1985
Practice Address - Fax:787-744-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16022261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR332572OtherREGISTER NUMBER