Provider Demographics
NPI:1801193065
Name:COMPCARE DE PUERTO RICO
Entity Type:Organization
Organization Name:COMPCARE DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-522-4400
Mailing Address - Street 1:METRO OFFICE PARK
Mailing Address - Street 2:PARKSIDE PLAZA 14 CALLE 12 SUITE 405
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1704
Mailing Address - Country:US
Mailing Address - Phone:787-522-4400
Mailing Address - Fax:787-522-4401
Practice Address - Street 1:METRO OFFICE PARK
Practice Address - Street 2:PARKSIDE PLAZA 14 CALLE 12 SUITE 405
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1704
Practice Address - Country:US
Practice Address - Phone:787-522-4400
Practice Address - Fax:787-522-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization