Provider Demographics
NPI:1558456616
Name:CENTRO DE INVESTIGACION EDUCACION Y SERVICIOS MEDICOS PARA LA DIABETES
Entity type:Organization
Organization Name:CENTRO DE INVESTIGACION EDUCACION Y SERVICIOS MEDICOS PARA LA DIABETES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BUSTELO SANCLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-753-8500
Mailing Address - Street 1:PMB #87
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-773-8283
Mailing Address - Fax:787-773-8303
Practice Address - Street 1:PRIMER PISO
Practice Address - Street 2:EDIF. DECANATO DE FARMACIA CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8344
Practice Address - Country:US
Practice Address - Phone:787-773-8283
Practice Address - Fax:787-773-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601539OtherMMM
PR100145OtherCRUZ AZUL DE PR
PR84864OtherSSS ENDO
PR9260286OtherHUMANA
PRPE SE 5110OtherPALIC
PR225074OtherPREFERRED HEALTH ENDO
PA56605OtherSSS PODO
PR228014OtherPREFERREDHEALTH PODO
PR1046OtherPMC
PR601539OtherMMM
PR22238Medicare PIN
PA56605OtherSSS PODO