Provider Demographics
NPI:1750719555
Name:CENTRO MEDICO LA ESPERANZA,P.S.C.
Entity type:Organization
Organization Name:CENTRO MEDICO LA ESPERANZA,P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ESPERANZA
Authorized Official - Last Name:MATOS MOQUETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-836-3409
Mailing Address - Street 1:604 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-1709
Mailing Address - Country:US
Mailing Address - Phone:787-836-3409
Mailing Address - Fax:787-836-3409
Practice Address - Street 1:604 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1709
Practice Address - Country:US
Practice Address - Phone:787-836-3409
Practice Address - Fax:787-836-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty