Basic Information
| Provider Information | |||||||||
| NPI: | 1245421908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORPORACION DE SALUD INTEGRAL Y | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6021 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007266021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872635136 | ||||||||
| FaxNumber: | 7872635136 | ||||||||
| Practice Location | |||||||||
| Address1: | HOSPITAL GENERAL MENONITA-CAYEY | ||||||||
| Address2: | EDIF PROF- SUITE 303 | ||||||||
| City: | CAYEY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875351001 | ||||||||
| FaxNumber: | 7875351034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | FERNANDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7874136196 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 14167 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.