Provider Demographics
NPI:1528222627
Name:CENTRO INTEGRAL MEDICINA AVANZADA (CIMA) CSP
Entity Type:Organization
Organization Name:CENTRO INTEGRAL MEDICINA AVANZADA (CIMA) CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-884-8680
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-884-8680
Mailing Address - Fax:
Practice Address - Street 1:CALLE HERNANDEZ CARRIO #E-33
Practice Address - Street 2:URB. ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41196Medicare UPIN