Provider Demographics
NPI:1992360440
Name:CENTRO DE SALUD DE LARES, INC
Entity Type:Organization
Organization Name:CENTRO DE SALUD DE LARES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2727
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0379
Mailing Address - Country:US
Mailing Address - Phone:787-897-2727
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:CARR 111 KM 1.9
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-897-2725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SALUD DE LARES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)