Provider Demographics
NPI:1255450441
Name:CENTRO ESPECIALISTA DE MEDICINA DEL ESTE C S P
Entity type:Organization
Organization Name:CENTRO ESPECIALISTA DE MEDICINA DEL ESTE C S P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:LOPEZ- COVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-852-0886
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0428
Mailing Address - Country:US
Mailing Address - Phone:787-852-0886
Mailing Address - Fax:787-852-0280
Practice Address - Street 1:AVE. FONT MARTELO # 334
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-852-0886
Practice Address - Fax:787-852-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10627261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care