1063625333 NPI number — CENTRO MED TURABO

Table of content: (NPI 1063625333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063625333 NPI number — CENTRO MED TURABO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO MED TURABO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCE EMERGENCY GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063625333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 GRAND BLVD PASEOS
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-5955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-292-0600
Provider Business Mailing Address Fax Number:
787-761-2094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SALA DE EMERGENCIA HIMA
Provider Second Line Business Practice Location Address:
AVE. MUNOZ MARIN, ESQ. DEGETAU
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-653-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAPULVEDA
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-292-0600

Provider Taxonomy Codes

  • Taxonomy code: 207PH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)