Provider Demographics
NPI:1598828766
Name:CENTRO ISABELINO MEDICINA AVANZADA
Entity Type:Organization
Organization Name:CENTRO ISABELINO MEDICINA AVANZADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-830-2765
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0737
Mailing Address - Country:US
Mailing Address - Phone:787-830-2765
Mailing Address - Fax:787-830-0465
Practice Address - Street 1:AVE AGUSTIN RAMOS CALERO INT 112
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0737
Practice Address - Country:US
Practice Address - Phone:787-830-2765
Practice Address - Fax:787-830-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR45146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10366Medicare ID - Type Unspecified