Provider Demographics
NPI:1760635031
Name:CENTRO DE DIABETES PARA PR
Entity Type:Organization
Organization Name:CENTRO DE DIABETES PARA PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINADOR PLANES MEDICOS
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-773-8283
Mailing Address - Street 1:PMB #87
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-773-8283
Mailing Address - Fax:787-773-8303
Practice Address - Street 1:PRIMER PISO EDIFICIO DECANATO DE FARMACIA CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8344
Practice Address - Country:US
Practice Address - Phone:787-773-8283
Practice Address - Fax:787-773-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNUT020OtherPREFERRED HEALTH
PR22238Medicare PIN