Provider Demographics
NPI:1558494252
Name:CENTRO DE MEDICINA DE FAMILIA
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA DE FAMILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWEN
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CATONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-733-3130
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-733-3130
Mailing Address - Fax:787-733-3130
Practice Address - Street 1:CALLE JOSE CELSO BARBOSA #219 EDIFICIO FARMACIA SURILLO
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-3130
Practice Address - Fax:787-733-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRW55491Medicare UPIN
PR82767Medicare PIN