Provider Demographics
NPI:1902221112
Name:CENTRO MEDICINA PIMARIA DR. PIMENTEL LEBRON, INC.
Entity Type:Organization
Organization Name:CENTRO MEDICINA PIMARIA DR. PIMENTEL LEBRON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:PIMENTEL LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-0062
Mailing Address - Street 1:PO BOX 33385
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0385
Mailing Address - Country:US
Mailing Address - Phone:787-842-0062
Mailing Address - Fax:787-284-1397
Practice Address - Street 1:1 CALLE BERTOLY
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3758
Practice Address - Country:US
Practice Address - Phone:787-842-0062
Practice Address - Fax:787-284-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10109208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10109OtherMEDICAL LICENSE NUMBER