Basic Information
Provider Information
NPI: 1598202681
EntityType: 2
ReplacementNPI:  
OrganizationName: CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GRUPO MEDICO CIMA
OtherOrganizationType: 3
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: CALLE SARGENTO GERARDO SANTIAGO
Address2: CARRETERA 14 INTERIOR
City: AIBONITO
State: PR
PostalCode: 007051379
CountryCode: US
TelephoneNumber: 7874341700
FaxNumber: 7874341714
Other Information
ProviderEnumerationDate: 01/26/2017
LastUpdateDate: 01/26/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RODRIGUEZ RAMOS
AuthorizedOfficialFirstName: LUIS
AuthorizedOfficialMiddleName: F
AuthorizedOfficialTitleorPosition: COORDINADOR FACTURACION Y COBRO CIM
AuthorizedOfficialTelephone: 7874341700
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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