Provider Demographics
NPI:1588858716
Name:CENTRO PROFESIONAL DE ENDOCRINOLOGIA DEL ESTE, C.S.P.
Entity Type:Organization
Organization Name:CENTRO PROFESIONAL DE ENDOCRINOLOGIA DEL ESTE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VERGARA-ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-266-0907
Mailing Address - Street 1:104 CALLE LUIS MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3103
Mailing Address - Country:US
Mailing Address - Phone:787-266-0907
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-266-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11856261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89908OtherSSS
PR0089908Medicare PIN