Provider Demographics
NPI:1598090987
Name:CORPORACION DE MEDICOS PRIMARIOS
Entity Type:Organization
Organization Name:CORPORACION DE MEDICOS PRIMARIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-845-6455
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0816
Mailing Address - Country:US
Mailing Address - Phone:787-845-6455
Mailing Address - Fax:787-845-8014
Practice Address - Street 1:BETANCES ST.
Practice Address - Street 2:#14
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-6455
Practice Address - Fax:787-845-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11271302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization