Provider Demographics
NPI:1578099974
Name:SERVICIOS MEDICOS EQR CSP
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS EQR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVARISTO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-868-4378
Mailing Address - Street 1:HC 58 BOX 14748
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00602
Mailing Address - Country:UM
Mailing Address - Phone:787-868-4378
Mailing Address - Fax:787-868-4378
Practice Address - Street 1:BO PIEDRAS BLANCAS DESVIO SUR NATIVO ALERS C417
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00602
Practice Address - Country:UM
Practice Address - Phone:787-868-4378
Practice Address - Fax:787-868-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10395302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1932255353Medicare PIN