Provider Demographics
NPI:1558776732
Name:A.S.L. CSP
Entity Type:Organization
Organization Name:A.S.L. CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-2548
Mailing Address - Street 1:790 CALLE ARBOLEDA
Mailing Address - Street 2:HACIENDAS CONSTANCIA
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-9618
Mailing Address - Country:US
Mailing Address - Phone:787-560-3209
Mailing Address - Fax:787-849-2548
Practice Address - Street 1:510 CARR #2
Practice Address - Street 2:SUITE 103 PLAZA CONSTANCIA
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-9745
Practice Address - Country:US
Practice Address - Phone:787-843-2548
Practice Address - Fax:787-849-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11976261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center