Provider Demographics
NPI:1750451704
Name:TELECOM DOCTORS, CSP
Entity Type:Organization
Organization Name:TELECOM DOCTORS, CSP
Other - Org Name:BODY HABITUS OBESITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:AURELIO
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-748-5306
Mailing Address - Street 1:PO BOX 70250
Mailing Address - Street 2:STE. 356
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8250
Mailing Address - Country:US
Mailing Address - Phone:787-748-5306
Mailing Address - Fax:787-748-5297
Practice Address - Street 1:LOS PASEOS MALL
Practice Address - Street 2:STE. 108A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-8250
Practice Address - Country:US
Practice Address - Phone:787-748-5306
Practice Address - Fax:787-748-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1437261070Medicare UPIN