Provider Demographics
NPI:1518266642
Name:CENTRO 4 MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:CENTRO 4 MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-760-1632
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1629
Mailing Address - Country:US
Mailing Address - Phone:787-760-1632
Mailing Address - Fax:787-760-9074
Practice Address - Street 1:EXPRESO TRUJILLO ALTO, ESQUINA SAINT JUST
Practice Address - Street 2:OFICINA 205
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-760-1632
Practice Address - Fax:787-760-9074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4717261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79383Medicare UPIN