Provider Demographics
NPI:1689179160
Name:CORPORACION DE SALUD ASEGURADA POR NUESTRA ORGANIZACION SOLIDARIA, INC
Entity Type:Organization
Organization Name:CORPORACION DE SALUD ASEGURADA POR NUESTRA ORGANIZACION SOLIDARIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-745-0340
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1025
Mailing Address - Country:US
Mailing Address - Phone:787-745-0340
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA RAFAEL CORDERO ESQ TROCHE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1621133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90772Medicaid