Provider Demographics
NPI:1619009529
Name:CENTRO FAMILIAR MEDICINA AVANZADA
Entity Type:Organization
Organization Name:CENTRO FAMILIAR MEDICINA AVANZADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-5790
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1388
Mailing Address - Country:US
Mailing Address - Phone:787-746-5790
Mailing Address - Fax:787-746-5790
Practice Address - Street 1:B1 CALLE LOPE FLORES
Practice Address - Street 2:URBANIZACION PARADIS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0000
Practice Address - Country:US
Practice Address - Phone:787-746-5790
Practice Address - Fax:787-746-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPMC MEDICARE CHOICE PROV
PR=========OtherMMM PROV NUM
PR=========OtherMMM PROV NUM
PRG37207Medicare UPIN