Provider Demographics
NPI:1710354899
Name:CANOVANAS MEDICAL CENTER CSP
Entity Type:Organization
Organization Name:CANOVANAS MEDICAL CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELLADO
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:787-876-5000
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00729
Mailing Address - Country:UM
Mailing Address - Phone:787-876-5000
Mailing Address - Fax:787-957-0761
Practice Address - Street 1:CALLE CORCHADO FINAL
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-5000
Practice Address - Fax:787-957-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care