Provider Demographics
NPI:1912109448
Name:CENTRO DR. EDWIN F. GIRAU NIEVES
Entity Type:Organization
Organization Name:CENTRO DR. EDWIN F. GIRAU NIEVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-2766
Mailing Address - Street 1:SABANA BRANCH P. O. BOX 948718
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694
Mailing Address - Country:US
Mailing Address - Phone:787-883-2711
Mailing Address - Fax:787-883-2725
Practice Address - Street 1:CALLE EMILIO GIBOYEAUX # 28
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-2766
Practice Address - Fax:787-883-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10829261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83035Medicare ID - Type Unspecified