Provider Demographics
NPI:1497257463
Name:CENTRO PRAY THE LORD INCORPORATED
Entity Type:Organization
Organization Name:CENTRO PRAY THE LORD INCORPORATED
Other - Org Name:PRAY THE LORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-614-3006
Mailing Address - Street 1:CARR 3 KM 11.6
Mailing Address - Street 2:BO MARTIN GONZALEZ
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986
Mailing Address - Country:US
Mailing Address - Phone:787-358-4139
Mailing Address - Fax:256-886-2900
Practice Address - Street 1:CARR 3 KM 11.6
Practice Address - Street 2:BO MARTIN GONZALEZ
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986
Practice Address - Country:US
Practice Address - Phone:787-358-4139
Practice Address - Fax:256-886-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98552084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty