Basic Information
| Provider Information | |||||||||
| NPI: | 1194959122 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRO CESKI C S P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 CALLE JOSE V RODRIGUEZ | ||||||||
| Address2: | |||||||||
| City: | PENUELAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006241807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 7878363288 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 CALLE JOSE V RODRIGUEZ | ||||||||
| Address2: | |||||||||
| City: | PENUELAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006241807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 7878363288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 06/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | ANGEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7878363288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 8333 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.