Provider Demographics
NPI:1528222676
Name:DAJAOS MEDICAL CENTER CSP
Entity Type:Organization
Organization Name:DAJAOS MEDICAL CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-730-3446
Mailing Address - Street 1:RR 14 BOX 5334
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-730-3446
Mailing Address - Fax:
Practice Address - Street 1:167 ROAD KM 11 0 BO DAJAOS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9711
Practice Address - Country:US
Practice Address - Phone:787-730-3446
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
PR894CP261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6320088OtherHUMANA
PR82154OtherSSS
PR500140OtherMMM
PR06548OOtherCRUZ AZUL
PR82154OtherSSS
PRUPIN BF25936 PRMedicare UPIN