Provider Demographics
NPI:1750990545
Name:CONCILIO DE SALUD INTEGRAL DE LOIZA INC
Entity type:Organization
Organization Name:CONCILIO DE SALUD INTEGRAL DE LOIZA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-876-2042
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772-0509
Mailing Address - Country:US
Mailing Address - Phone:787-876-2042
Mailing Address - Fax:787-256-1900
Practice Address - Street 1:673 CALLE ESCOLASTICO LOPEZ
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2834
Practice Address - Country:US
Practice Address - Phone:787-936-2006
Practice Address - Fax:787-256-1900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONCILIO DE SALUD INTEGRAL DE LOIZA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)