Provider Demographics
NPI:1639687734
Name:CENTRO DE MEDICINA PRIMARIA DRA. KARLA M. BORRERO CUELLO, LLC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PRIMARIA DRA. KARLA M. BORRERO CUELLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORRERO CUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-9595
Mailing Address - Street 1:PO BOX 8753
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8753
Mailing Address - Country:US
Mailing Address - Phone:787-812-9595
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE VICTORIA STE 105
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3780
Practice Address - Country:US
Practice Address - Phone:787-812-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16536208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1760594220Medicaid