Provider Demographics
NPI:1851508907
Name:CENTRO MEDICO DEL TURABO INC
Entity Type:Organization
Organization Name:CENTRO MEDICO DEL TURABO INC
Other - Org Name:GRUPO EMERGENCIAS PEDIATRICAS BAYAMON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:787-653-3434
Mailing Address - Street 1:PO BOX 4980
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-620-4307
Mailing Address - Fax:787-620-4307
Practice Address - Street 1:HIMA SAN PABLO BAYAMON
Practice Address - Street 2:URB SANTA CRUZ SANTA CRUZ 70
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-620-4320
Practice Address - Fax:787-620-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12642OtherMED LICENSE
PR15014OtherMED LICENSE
PR6001OtherMED LICENSE
PR12892OtherMED LICENSE
PR13925OtherMED LICENSE
PR5683OtherMED LICENSE
PR11881OtherMED LICENSE
PR6955OtherMED LICENSE
PR15840OtherMED LICENSE
PR15872OtherMED LICENSE
PR6645OtherMED LICENSE
PR11903OtherMED LICENSE
PR15636OtherMED LICENSE
PR14533OtherMED LICENSE