Basic Information
| Provider Information | |||||||||
| NPI: | 1528456746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRO MEDICO DEL TURABO, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIMA SAN PABLO - CUPEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PMB 250 | ||||||||
| Address2: | 138 WINSTON CHURCHILL | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877618383 | ||||||||
| FaxNumber: | 7877482065 | ||||||||
| Practice Location | |||||||||
| Address1: | CARR. 844, KM. 0.5 | ||||||||
| Address2: | CUPEY BAJO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877618383 | ||||||||
| FaxNumber: | 7877482065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JOAQUIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN, CEO | ||||||||
| AuthorizedOfficialTelephone: | 7876533434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | JD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.