Provider Demographics
NPI:1679981047
Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.-MAUNABO
Entity Type:Organization
Organization Name:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.-MAUNABO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-861-4320
Mailing Address - Street 1:45 MUNOZ RIVERA STRET
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2146
Practice Address - Country:US
Practice Address - Phone:787-861-4320
Practice Address - Fax:787-861-4443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080082Medicare UPIN