Provider Demographics
NPI:1528417268
Name:CENTRO DE SERVICIOS DE SALUD DE BAYAMON
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS DE SALUD DE BAYAMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEC
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-520-8449
Mailing Address - Street 1:IF48 AVE LOMAS VERDES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3114
Mailing Address - Country:US
Mailing Address - Phone:787-520-8449
Mailing Address - Fax:
Practice Address - Street 1:150 AVE LOS CONQUISTADORES
Practice Address - Street 2:MARINA BAHIA PLAZA LOCAL 1
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-520-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16122261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service