Basic Information
| Provider Information | |||||||||
| NPI: | 1013062900 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRO DE DIABETES Y OSTEOPOROSIS DE PR | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 363929 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009363929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877661087 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CALLE 42 SE #1012 | ||||||||
| Address2: | REPARTO METROPOLITANO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877661087 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | ALEGRE | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7877661087 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD,FACE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 10254 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.