Basic Information
| Provider Information | |||||||||
| NPI: | 1851508907 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRO MEDICO DEL TURABO INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | GRUPO EMERGENCIAS PEDIATRICAS BAYAMON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 4980 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876204307 | ||||||||
| FaxNumber: | 7876204307 | ||||||||
| Practice Location | |||||||||
| Address1: | HIMA SAN PABLO BAYAMON | ||||||||
| Address2: | URB SANTA CRUZ SANTA CRUZ 70 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876204320 | ||||||||
| FaxNumber: | 7876204765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7876533434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LCDC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12642 | 01 | PR | MED LICENSE | OTHER | 15014 | 01 | PR | MED LICENSE | OTHER | 6001 | 01 | PR | MED LICENSE | OTHER | 12892 | 01 | PR | MED LICENSE | OTHER | 13925 | 01 | PR | MED LICENSE | OTHER | 5683 | 01 | PR | MED LICENSE | OTHER | 11881 | 01 | PR | MED LICENSE | OTHER | 6955 | 01 | PR | MED LICENSE | OTHER | 15840 | 01 | PR | MED LICENSE | OTHER | 15872 | 01 | PR | MED LICENSE | OTHER | 6645 | 01 | PR | MED LICENSE | OTHER | 11903 | 01 | PR | MED LICENSE | OTHER | 15636 | 01 | PR | MED LICENSE | OTHER | 14533 | 01 | PR | MED LICENSE | OTHER |