Provider Demographics
NPI:1699200907
Name:NEOMED CENTER, INC.
Entity Type:Organization
Organization Name:NEOMED CENTER, INC.
Other - Org Name:NEOMED CENTER-CL-IMMUNIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-737-2311
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1277
Mailing Address - Country:US
Mailing Address - Phone:787-737-2311
Mailing Address - Fax:787-737-2377
Practice Address - Street 1:CARR 189 KM 6.0
Practice Address - Street 2:RINCON INDUSTRIAL PARK
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center