Provider Demographics
NPI:1851050801
Name:CENTRO NATURISTA DE CAGUAS
Entity Type:Organization
Organization Name:CENTRO NATURISTA DE CAGUAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:NL
Authorized Official - Phone:787-922-7381
Mailing Address - Street 1:URB BAIROA CALLE 24
Mailing Address - Street 2:BE 11
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-922-7381
Mailing Address - Fax:
Practice Address - Street 1:AVE LAS AMERICAS URB BAIROA CALLE 4
Practice Address - Street 2:CC8
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-367-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4366720OtherLISCENSE