Provider Demographics
NPI:1942641154
Name:PROGRAMA CUIDADO INTEGRAL DEL SIDA
Entity Type:Organization
Organization Name:PROGRAMA CUIDADO INTEGRAL DEL SIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EJECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELICIANO-SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-852-0768
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0859
Mailing Address - Country:US
Mailing Address - Phone:787-852-0768
Mailing Address - Fax:787-656-0735
Practice Address - Street 1:355 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:787-656-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15F2515261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0436140001OtherMEDICARE
PR407005Medicare PIN
PR0436140001OtherMEDICARE
PR405018Medicare Oscar/Certification