Provider Demographics
NPI:1952967564
Name:CENTRO DE SALUD CONDUCTUAL MENONITA CIMA
Entity Type:Organization
Organization Name:CENTRO DE SALUD CONDUCTUAL MENONITA CIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1715
Practice Address - Street 1:LA FUENTE TOWN CENTER
Practice Address - Street 2:AVE PEDRO ALBIZU CAMPOS MARGINAL SUITE 109
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0011
Practice Address - Country:US
Practice Address - Phone:787-437-1700
Practice Address - Fax:787-434-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SALUD CONDUCTUAL MENONITA CIMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6OtherLICENCE OF HEALTH DEPARTMENT