Basic Information
Provider Information | |||||||||
NPI: | 1568594703 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CENTRO DE SALUD FAMILIAR OROCOVIS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOSPITAL MENONITA AIBONITO | ||||||||
OtherOrganizationType: | 4 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 372800 | ||||||||
Address2: |   | ||||||||
City: | CAYEY | ||||||||
State: | PR | ||||||||
PostalCode: | 007372800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7874341700 | ||||||||
FaxNumber: | 7874341714 | ||||||||
Practice Location | |||||||||
Address1: | CARRETERA 155 AVE LUIS MUNOZ MARIN | ||||||||
Address2: | SECTOR EL DESVIO | ||||||||
City: | OROCOVIS | ||||||||
State: | PR | ||||||||
PostalCode: | 00720 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7875351001 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/12/2007 | ||||||||
LastUpdateDate: | 02/23/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VAZQUEZ-RIVERA | ||||||||
AuthorizedOfficialFirstName: | LISSETTE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 7874341700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HOSPITAL MENONITA AIBONITO | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 291U00000X |   |   | N |   | Laboratories | Clinical Medical Laboratory |   | 261QE0002X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
ID | Type | State | Issuer | Description | 54 | 01 | PR | HEALTH DEPARTMENT | OTHER |