Provider Demographics
NPI:1699366872
Name:CENTRO MEDICO DOS PALMAS INC
Entity Type:Organization
Organization Name:CENTRO MEDICO DOS PALMAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ARANZAZU
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-975-6807
Mailing Address - Street 1:1443 AVE. BOULEVARD
Mailing Address - Street 2:LEVITOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-795-1165
Mailing Address - Fax:787-795-1165
Practice Address - Street 1:1443 AVE. BOULEVARD
Practice Address - Street 2:LEVITOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-1165
Practice Address - Fax:787-795-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037793100Medicaid