Basic Information
| Provider Information | |||||||||
| NPI: | 1508079732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CESKI | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10730 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007320730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 7878363288 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 JOSE VICENTE RODRIGUEZ | ||||||||
| Address2: | |||||||||
| City: | PENUELAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878363288 | ||||||||
| FaxNumber: | 7878363288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANTOS ONODA | ||||||||
| AuthorizedOfficialFirstName: | KIYOMI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878363288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.