Provider Demographics
NPI:1245809862
Name:CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA COSSMA
Entity type:Organization
Organization Name:CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA COSSMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD MILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-739-8182
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1330
Mailing Address - Country:US
Mailing Address - Phone:787-739-8182
Mailing Address - Fax:
Practice Address - Street 1:PR-14 KM 80.4 PARQUE INDUSTRIAL BO PUEBLO
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty