Provider Demographics
NPI:1932478914
Name:CENTRO INTEGRADO DE TRATAMIENTOS DE SALUD
Entity Type:Organization
Organization Name:CENTRO INTEGRADO DE TRATAMIENTOS DE SALUD
Other - Org Name:EVEREST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:DOLORES
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-717-8424
Mailing Address - Street 1:1257 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1619
Mailing Address - Country:US
Mailing Address - Phone:787-782-6736
Mailing Address - Fax:787-781-1272
Practice Address - Street 1:1257 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1619
Practice Address - Country:US
Practice Address - Phone:787-782-6736
Practice Address - Fax:787-781-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty