Provider Demographics
NPI:1497986574
Name:CLINICA BORINQUEN MEDICAL SERVICES, CSP
Entity Type:Organization
Organization Name:CLINICA BORINQUEN MEDICAL SERVICES, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OMAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-762-9409
Mailing Address - Street 1:URB COUNTRY CLUB PQ-24
Mailing Address - Street 2:AVE EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-762-9409
Mailing Address - Fax:787-701-1134
Practice Address - Street 1:URB COUNTRY CLUB PQ-24
Practice Address - Street 2:AVE EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-762-9409
Practice Address - Fax:787-701-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10994208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10994OtherLICENCIA