Provider Demographics
NPI:1760684971
Name:CENTRO MEDICO BORINQUEN INC
Entity Type:Organization
Organization Name:CENTRO MEDICO BORINQUEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-1577
Mailing Address - Street 1:15341 SW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4379
Mailing Address - Country:US
Mailing Address - Phone:305-300-1577
Mailing Address - Fax:305-779-6969
Practice Address - Street 1:CALLE 1 A-5 ALTOS
Practice Address - Street 2:URB. CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-648-7171
Practice Address - Fax:787-961-6086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEDIGIA INVESTMENT CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center