Provider Demographics
NPI:1578806949
Name:CENTRO DE MEDICINA PRIMARIA Y PREVENTIVA, PSC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PRIMARIA Y PREVENTIVA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIVERA-GUILBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-975-1279
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0282
Mailing Address - Country:US
Mailing Address - Phone:787-975-1279
Mailing Address - Fax:
Practice Address - Street 1:CARR. 537 FINAL PLAYITA CORTADA
Practice Address - Street 2:MINI MALL # 10
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-975-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty