Provider Demographics
NPI:1013062900
Name:CENTRO DE DIABETES Y OSTEOPOROSIS DE PR
Entity type:Organization
Organization Name:CENTRO DE DIABETES Y OSTEOPOROSIS DE PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEGRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACE
Authorized Official - Phone:787-766-1087
Mailing Address - Street 1:PO BOX 363929
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3929
Mailing Address - Country:US
Mailing Address - Phone:787-766-1087
Mailing Address - Fax:
Practice Address - Street 1:CALLE 42 SE #1012
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-766-1087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10254261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDR194ZMedicare PIN