Provider Demographics
NPI:1588836290
Name:CICER CSP CENTRO INTEGRAL DE CIRUGIA ESTETICA
Entity Type:Organization
Organization Name:CICER CSP CENTRO INTEGRAL DE CIRUGIA ESTETICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-986-7085
Mailing Address - Street 1:410 AVE HOSTOS
Mailing Address - Street 2:CENTRO MEDICO DE MAYAGUEZ
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1560
Mailing Address - Country:US
Mailing Address - Phone:787-986-7085
Mailing Address - Fax:787-986-7086
Practice Address - Street 1:410 AVE HOSTOS
Practice Address - Street 2:CENTRO MEDICO DE MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1560
Practice Address - Country:US
Practice Address - Phone:787-986-7085
Practice Address - Fax:787-986-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13636261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center