Provider Demographics
NPI:1760676704
Name:CENTRO VISUAL MOROVIS
Entity Type:Organization
Organization Name:CENTRO VISUAL MOROVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINES
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-862-3278
Mailing Address - Street 1:26 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-862-6264
Practice Address - Street 1:26 BUENA VISTA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0729
Practice Address - Country:US
Practice Address - Phone:787-862-3278
Practice Address - Fax:787-862-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0265261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care