Provider Demographics
NPI:1922757004
Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD DE PATILLAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:MOREL
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:787-839-4320
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0697
Mailing Address - Country:US
Mailing Address - Phone:787-839-4320
Mailing Address - Fax:787-271-0004
Practice Address - Street 1:CALLE BARBOSA #114 ESQ. DIOSDADO DONES
Practice Address - Street 2:COMUNIDAD EL COCO BARRIO LAPA
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-0000
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-750092OtherSTATE PHARMACY LICENSE