Basic Information
| Provider Information | |||||||||
| NPI: | 1710107883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRO MEDICO DEL TURABO INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | RED MEDICA HIMA SAN PABLO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 4980 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007264980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 7876533517 | ||||||||
| Practice Location | |||||||||
| Address1: | HIMA SAN PABLO CAGUAS | ||||||||
| Address2: | URB MARIOLGA #100 AVE LUIS MUNOZ MARIN | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
| FaxNumber: | 7876533517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7876533434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | HMSA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1093843096 | 01 | PR | NEUROLOGY NPI GROUP | OTHER | 1811039514 | 01 | PR | PED NEUMOLOGY NPI GRP | OTHER | 1992848907 | 01 | PR | PED GASTRO NPI GROUP | OTHER | 1104043686 | 01 | PR | NUCLEAR MEDICINE NPI GRP | OTHER | 1164566220 | 01 | PR | PED HOSPITALIST FAJ NPIGR | OTHER | 1811031933 | 01 | PR | PED RHEUMATOLOGY NPI GROU | OTHER | 1477697597 | 01 | PR | PED HEMA ONCO NPI GRP | OTHER | 1689728875 | 01 | PR | GENERAL SURGERY NPI GROUP | OTHER | 1205052248 | 01 | PR | OB GYN FAJARDO NPI GRP | OTHER | 1215081492 | 01 | PR | HOUSE PHYSICIAN NPI GROUP | OTHER | 1720122849 | 01 | PR | PED NEPHRO NPI GRP | OTHER | 1174740666 | 01 | PR | PED INFECT NPI GROUP | OTHER | 1568506681 | 01 | PR | GASTROENTEROLOGY NPI GRP | OTHER | 1720205289 | 01 | PR | PED ORTHOPEDY NPI GROUP | OTHER | 1376671081 | 01 | PR | NEUROSURGERY NPI GRP | OTHER | 1639212640 | 01 | PR | PED OTORRHINOL NPI GRP | OTHER | 1912040916 | 01 | PR | OTORRHINOL NPI GRP | OTHER | 1083758163 | 01 | PR | PED EMERG FAJARDNPI GROUP | OTHER | 1689891160 | 01 | PR | PED SURGERY NPI GROUP | OTHER |