Provider Demographics
NPI:1962472845
Name:CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO INC
Entity Type:Organization
Organization Name:CENTRO DE CIRUGIA AMBULATORIA LASER MEDICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TOLLINCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-0404
Mailing Address - Street 1:MEDICAL OPHTHALMIC PLAZA
Mailing Address - Street 2:1875 CARR 2 SUITE 303
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7217
Mailing Address - Country:US
Mailing Address - Phone:787-780-0404
Mailing Address - Fax:787-780-0411
Practice Address - Street 1:MEDICAL OPHTHALMIC PLAZA
Practice Address - Street 2:1875 CARR 2 SUITE 303
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7217
Practice Address - Country:US
Practice Address - Phone:787-780-0404
Practice Address - Fax:787-780-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3 CNC 97 206261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3CNC97206OtherAMBULATORY SURGERY CENTER
PR3CNC97206OtherAMBULATORY SURGERY CENTER